Lesson Objectives:

• Classify HFrEF vs. HFpEF and their respective treatments.

• Discuss acute vs. chronic heart failure management.

• Review cardiomyopathy types (ischemic, hypertrophic, dilated, restrictive).

Types of Heart Failure

🔹 HFrEF (Heart Failure with Reduced Ejection Fraction, EF <40%)

• Causes: Ischemic heart disease, dilated cardiomyopathy, myocarditis.

• Treatment:
  ✔️ Beta-blockers (carvedilol, metoprolol, bisoprolol) – reduce mortality.
  ✔️ ACE inhibitors/ARBs/ARNI (sacubitril-valsartan) – prevent remodeling.
  ✔️ Spironolactone (aldosterone antagonist) – for NYHA II-IV.
  ✔️ SGLT2 inhibitors (dapagliflozin, empagliflozin) – emerging therapy.
  ✔️ Diuretics (furosemide, torsemide) – for symptomatic relief.

🔹 HFpEF (Heart Failure with Preserved Ejection Fraction, EF >50%)

• Causes: Hypertension, LVH, aging, restrictive cardiomyopathies.

• Treatment:
  ✔️ Diuretics – for fluid overload.
  ✔️ BP control – ARBs, beta-blockers.
  ✔️ SGLT2 inhibitors – new evidence for HFpEF.

🔹 Acute Decompensated Heart Failure (ADHF)
🚑 Treatment (“LMNOP” Mnemonic)

• L – Loop diuretics (furosemide IV).

• M – Morphine (controversial, may reduce dyspnea).

• N – Nitroglycerin (if hypertensive).

• O – Oxygen (if hypoxic).

• P – Positive pressure ventilation (BiPAP for pulmonary edema).

Cardiomyopathies

🔹 Dilated Cardiomyopathy (DCM): Systolic dysfunction, causes include viral myocarditis, alcohol, genetic mutations.
🔹 Hypertrophic Cardiomyopathy (HCM): LVH + diastolic dysfunction, risk of sudden cardiac death (SCD) in young athletes.
🔹 Restrictive Cardiomyopathy (RCM): Stiff myocardium, seen in amyloidosis, sarcoidosis.