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Cardiovascular Medicine Strategies to prevent readmission include o treatment of re'uersible causes of HF exacerbation o euvolemia achieved with diuresis o medicationreconciliation . discharge with medications that reduce mortality and morbidity o patient education on HF physiologr . home nurse follow up (or phone call within 48 h) soon after discharge . follow-up appointment (within 7 days) Follow-up ln patients with chronic HF who experience a change in clinical symptoms, fbllow up echocardiography is recommended. Heart Failure With Preserved Ejection Fraction Diagnosis Diagnose HFpEF when signs and symptoms of HF are present but the echocardiogram reveals EF >50'2, and significant valvular abnormalities are absent. Treatment of HFpEF The primary treatment goals in HFpEF are to treat the underlying cause (hypertension, AF), to manage potentially exacerbating factors (e.g., tachycardia), and to optimize diastolic filling (control HR and avoid decreased effective circulating blood volume). Diuretics should be used when volume overl<-rad is present. DOil'T BE TRICKED . No drug has been clearly shown to decrease morbidity and mortality in patients with HFpEF Nonischemic Dilated Cardiomyopathy Diagnosis Dilated cardiomyopathy is characterized by dilation and reduced f'unction of one or both ventricles manifesting as HF, arrhyth- mias. and sudden death. The most common cause is idiopathic ditated cardiomyopathy (50%), but the differential diagnosis is broad.

DOil'T BE TRICKED . No drug has been clearly shown to decrease morbidity and mortality in patients with HFpEF Nonischemic Dilated Cardiomyopathy Diagnosis Dilated cardiomyopathy is characterized by dilation and reduced f'unction of one or both ventricles manifesting as HF, arrhyth- mias. and sudden death. The most common cause is idiopathic ditated cardiomyopathy (50%), but the differential diagnosis is broad. STUDY TABLE: Differential Diagnoses of Nonischemic Dilated Cardiomyopathy Condition Distinguishing Characteristics Acute myocarditis Associated with bacterial, viral, and parasitic infections and autoimmune disorders. Cardiac troponin levels are typically elevated; ventricular dysfunction may be global or regional. Can cause cardiogenic shock and ventricular arrhythmias. Choose supportive care in the acute phase and then standard HF therapy. Alcoholic Associated with chronic heavy alcohol ingestion, but other manifestations of chronic alcohol abuse may be cardiomyopathy absent. Typically, the LV (and frequently both ventricles) is dilated and hypokinetic. Choose standard HF therapy and total abstinence from alcohol. (Continued on the next page) I