Changes

=Congestive Heart Failure=

=Congestive Heart Failure=

* Systolic Dysfunction/HFrEF

* Systolic Dysfunction/HFrEF

** H&P: History of CAD, hypertension, valvular disease, dilated cardiomyopathy (EtOH, Chagas, Coxsackie B), or MI. Dyspnea, PND, orthopnea, cough, hemoptysis, fatigue; S3, displaced PMI, crackles, signs of right heart failure (S4, JVD, edema)

** H&P: History of CAD, hypertension, valvular disease, dilated cardiomyopathy (EtOH, Chagas, Coxsackie B), or MI. '''Dyspnea (most sensitive)''', PND, orthopnea, cough, hemoptysis, fatigue; '''S3 (most specific)''', displaced PMI, crackles, signs of right heart failure (S4, JVD, edema)

** Dx: LVEF < 40%, enlarged cardiomediastinal silhouette on CXR, elevated BNP

** Dx: LVEF < 40%, enlarged cardiomediastinal silhouette on CXR, elevated BNP

** Tx: ACEI/ARBs, ARNIs, β blockers, SGLT2 inhibitors, Spironolactone, and LVAD all have mortality benefit; Digoxin and diuretics don't have any mortality benefit but help with symptoms and decrease hospitalizations. For acute exacerbations use LMNOP (lasix, morphine, '''nitrates''', oxygen, positioning).

** Tx: ACEI/ARBs, ARNIs, β blockers, SGLT2 inhibitors, Spironolactone, and LVAD all have mortality benefit; Digoxin and diuretics don't have any mortality benefit but help with symptoms and decrease hospitalizations. For acute exacerbations use LMNOP (lasix, morphine, '''nitrates''', oxygen, positioning).