#135 Guideline Directed Medical Therapy Part II: 5 Pearls Segment

Core IM | Internal Medicine Podcast

Core IM Team

Mental Health, Education, Health & Fitness, Medicine

4.8 • 1K Ratings

🗓️ 20 September 2023

⏱️ 38 minutes

🔗️ Recording | iTunes | RSS

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Summary

With progressing CKD & HFrEF, what GDMT medications can you start, continue or stop? What does the data on hydralazine/isosorbide tell us and what does it NOT tell us? What are the pros and cons of starting GDMT inpatient versus outpatient? Do you still keep patients on GDMT once their EF recovers?

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Timestamps

01:54 Pearl 1 – Recap of GDMT and CKD
09:15 Pearl 2 – Hydralazine and Isosorbide Dinitrate
20:59 Pearl 3 – Ivabradine
25:47 Pearl 4 – Inpatient vs Outpatient Initiation of GDMT
30:55 Pearl 5 – Ejection Fraction Recovery

Tags: IMCore, CoreIM, hydralazine, heart failure reduced ejection fraction, HFmrEF, HFimpEF, chronic kidney disease, cardiology

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Transcript

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0:00.0	Welcome to the Corion Thy Prels Podcast,
0:04.0	for new high-yield evidence-based pearls.
0:06.0	This is Dr. Shurajajevetti, an internist at Beth Israel-Dekinist Medical Center,
0:10.0	and Dr. Victoria-Medevic Cardenovic Cardiology Fellow at Beth Israel Deaconess Medical Center.
0:14.6	Today we will be focusing on guideline directed medical therapy, aka GDMT, in
0:19.6	heart failure with a reduced ejection fraction part two.
0:23.0	Shreya let's get right into it.
0:25.0	We got a lot of good ground to cover.
0:27.0	Yes, yes.
0:28.0	Test yourself by pausing after each of the five questions.
0:31.0	Remember, the more you test yourself the deeper your learning
0:33.6	gains. Pearl 1 recap of GDMT and CKD. With progressive CKD what
0:41.7	GDMT medications can you start, continue, or stop?
0:45.6	Pearl 2, hydrolyzine and isosorbide Pearl-2,
0:52.8	hydrolyzine and isosorbide dinitrate.
0:55.6	What does the data on hydroisosorbide tell us?
0:58.3	And what does it not tell us?
0:59.6	And what are the medications limitations? Pearl 3, I'veabredine.
1:10.0	What do you do if your patient's heart rate is still above 70 despite maximal beta blockade?
1:17.0	Pearl 4 inpatient versus outpatient
1:25.0	inpatient
1:26.0	versus outpatient initiation of GDMT.
	...

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