53

STAGE A
STAGE A
STAGE B
STAGE C
Refractory
HF requiring
specialized interventions
HF but without structuralStructural
heart disease
ordisease
simptoms
HF
heart
butof
without
sign
structural
or simptoms
heart disease
of HF with prior or current
simptoms
of HF

e.g : patients with

e.g : patients with
e.g : patients with who have marked symptoms at rest despite maximal medical theraphy (e.g, those who are recurrently hospitalized or canno
known structural heart disease
- hipertension
and
e.g : patients with
- Atherosclerotic disease
- shortness of breath and fatigue reduced exercise tolerance
- Previous MI
- diabetes
- LV modelling including LVH and low EF
- obesit
Structural- asimptomvalvular
heart disease
disease
- metabolic sindrome or
Refractory symptoms of HF at rest
Development of simptom of HF
Patient
-using cardiotoxins
- with FHx CM

THERAPY
THERAPY
GOALS
THERAPY
GOALS
All measures under stage A and B
THERAPY
ion
All measures under stage A
DRUGS FOR ROUTNE USE - Apropriate measures under stage A, B and C
king cessation
DRUGS
Diuretics for field retention
- Decision reapropriate level of care
rdes encourage regular exercise ACEI or ARB in apropriate patients (see text)
ACEI
OPTIONS
ohol intake, ill og drug use
Beta-blockers in approprate patient (see text)
Beta-blockers
Compassionate and of life care/hospice
olic syndrome
DRUGS IN
Extraordinary measures
DRUGS
SELECTED PATIENS
Heart tranplant
apropriate patients (see text) for vascular disease or diabetes
aldosterone antagonist
Chronic inotropes
ARBs
Permanent mechanical support
Digitalis
Experinental surgery or drugs
Hydralazine titrates
DEVICES IN SELECTED PATIENTS
Biventricular pacing
Implantabe defibrilators

Gambar 4. Algoritma penanganan gagal jantung / rekomendasi terapi menurut WHO

(Hunt SA, Abraham WT, et all 2005)