Uganda guidelines for the treatment of Heart Failure
Uganda Clinical Guidelines 2023 · all from source →
General Adult
Diagnosis
Clinical Features (Older Children/Adults)
Palpitations, shortness of breath, exercise intolerance, orthopnea, wheezing. Rapid pulse, gallop rhythm. Raised JVP. Dependent oedema, enlarged tender liver, basal crepitations.
Clinical Features (Infants)
Respiratory distress (cyanosis, wheezing, recession). Rapid pulse, gallop rhythm, excessive sweating, tender hepatomegaly, difficulty feeding.
Investigations
Chest X-ray, Echocardiogram, ECG. U&Es, Haemogram.
Treatment
General Measures
Bed rest with head of bed elevated/sitting position. Reduce salt intake and limit fluid intake (1-1.5 L/ day).
Diuretics
Furosemide 20-40 mg oral or IV daily or every 12 hours, increasing as required to 80-160 mg. Child: 1 mg/kg oral or IV (max: 8 mg/kg daily).
ACE Inhibitors
Enalapril: start with 2.5 mg once daily, increase gradually over 2 weeks to 10-20 mg (max 40 mg). OR Lisinopril 5mg up to 40mg. Child: Enalapril 0.1-1 mg/kg daily in 1-2 doses OR Captopril 0.1-0.3 mg/kg daily.
Beta Blockers
When patient stable: Carvedilol 3.125 mg every 12 hours, increase gradually to max 25 mg 12 hourly. OR Bisoprolol 1.25mg once daily increase gradually to max 10mg. Child: Carvedilol 0.05 mg/kg every 12 hours.
Second/Third Line
Spironolactone 25-50 mg once a day (Child: 1.5-3 mg/kg daily). Digoxin 125-250 micrograms/daily (Child: 15 micrograms/kg daily).
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