Heart failure pearls

Alpha blockers should be avoided in hypertensives with heart failure as they can cause retention of salt and water.

Number needed to treat in heart failure trials is lower for carvedilol compared to other beta blockers.

Stroke risk in atrial fibrillation increases when they develop heart failure and calls for anticoagulation. But dose titration may be difficult due to associated liver dysfunction.

There is some data that prolactin has a role in peripartum cardiomyopathy and bromocryptine is being tried in the treatment of peripartum cardiomyopathy.

There is 14 fold increase in atrial fibrillation in Conn syndrome. This is thought to be due to atrial fibrosis caused by aldosterone excess. Thus aldosterone antagonists have a role in preventing atrial fibrillation by reducing atrial remodeling.

Central sleep apnea in heart failure may respond to small doses of theophylline. Higher doses can increase the tendency to ventricular arrhythmias. Another modality evalutated for central sleep apnea is pacing of the prenic nerve during the apneic phase.

Bioavailability of oral torsemide is higher (about 80%) in heart failure compared to frusemide (about 40%). Frusemide infusion is useful in acute decompensated heart failure. But high cumulative daily doses can cause ototoxicity.

Ultrafiltration is useful in treating pulmonary edema in renal failure.