The CardioNerds and Dr. Gregg Fonarow on Modifying a Heart Failure Medication Regimen

By CardioNerds - Last Updated: December 11, 2023

In this podcast episode, The CardioNerds answer the following question, which refers to Section 7.3 of the 2022 ACC/AHA/HFSA Guideline for the Management of Heart Failure.

Mr. Gene D’aMeTi, a 53-year-old Black man with ischemic cardiomyopathy and heart failure with reduced ejection fraction (LVEF 30%-35%), was recently admitted with acutely decompensated heart failure and acute kidney injury with stage III chronic kidney disease. His outpatient regimen includes sacubitril-valsartan 97-103 mg BID, carvedilol 25 mg BID, and hydralazine 50 mg TID.

Sacubitril-valsartan was held because of worsening renal function. Despite symptomatic improvement with diuresis, the patient’s renal function continues to decline. He is otherwise well perfused, with preservation of other end organ function.

Throughout his hospitalization, the patient has steadily become more hypertensive, with blood pressure persisting in the range of 170s/90s mmHg.

What would be an appropriate adjustment to his medication regimen at this time?

A Resume losartan only
B Start amlodipine
C Increase current hydralazine dose
D Start isosorbide dinitrate therapy
E Both C and D

The question is answered first by The CardioNerds Academy faculty member Dr. Ty Sweeny, of Hopkins Bayview, and then by expert faculty Dr. Gregg Fonarow, of the Division of Cardiology at the University of California, Los Angeles.

*Find the answer at 3:28 of the episode.

The Decipher the Guidelines: 2022 ACC/AHA/HFSA Guideline for the Management of Heart Failure series was developed by The CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was produced by 30 trainees—spanning the education spectrum from college through advanced fellowship—under the leadership of The CardioNerds co-founders, Drs. Amit Goyal and Dan Ambinder, with mentorship from Drs. Anu Lala, Robert Mentz, and Nancy Sweitzer. The CardioNerds would like to thank Drs. Judy Bezanson and Elliott Antman for their tremendous guidance.

This podcast originally appeared on The CardioNerds.


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