Heart Failure Pearls

HFpEF – HF with preserved ejection fraction (“hef-ref”)
HFrEF – HF with reduced ejection fraction (“hef-pef”)
HFrEF has all the high-level evidence:  beta-blockers, ACEI, spironolactone – all indicated for NYHA II (with rales) – IV
– push these cheap meds to patient side-effects or lab abnormalities
Gotta be checking K if you’re adding ACEI and spironolactone!
Diuretics are key – but the patient has to be euvolemic for these to be effective.
Furosemide:  bioavailability 10-90%!  Varies widely with gut-wall edema.
Bumetanide:  serum bioavailability much more predictable.
Torsemide:  serum bioavailability much more predictable, but not on the $4 list.

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