Heart failure

Insufficientia cordis · Srdeční selhání

What it is

The pump can't keep up with the body's demand; fluid backs up.

call 112 / 911 now Severe breathlessness at rest or pink frothy cough
call 112 / 911 now Chest pain, fainting or a racing heartbeat
see a doctor soon Weight up 2 kg or more in 3 days
see a doctor soon More swelling, or needing more pillows to breathe at night

The four pillars when the pump is weakened (reduced ejection fraction): ACE-I/ARNI, beta blocker, MRA, SGLT2 inhibitor
diuretics for fluid
devices (CRT, ICD)
LVAD or transplant in end stage
cardiac contractility modulation (Optimizer) — FDA-approved 2019 to ease symptoms in selected patients; no survival data

Salt below 5 g a day — trials are weaker than the advice suggests mixed evidence
Daily weight tracking, which catches fluid early trials support
Fluid limits mixed evidence
Supervised exercise training — fewer admissions trials support
Stopping alcohol when it is the cause trials support
Flu vaccination — in the IVVE trial fewer pneumonias and hospital admissions, but no clear fall in its main combined outcome mixed evidence

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

Coenzyme Q10 — the Q-SYMBIO trial found fewer cardiac deaths; not yet repeated mixed evidence
Intravenous iron when iron-deficient — trials show better exercise capacity and fewer admissions (now in guidelines) trials support
Hawthorn (Crataegus) — better symptoms in small trials; no effect on events in the large SPICE trial mixed evidence
D-ribose and L-carnitine — small studies of heart energy metabolism early / small studies
Thiamine in diuretic-treated patients — small trials, mixed results mixed evidence