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Heart Failure (HFrEF)

Cardiovascular · ~11% of blueprint
Pathophysiology
Reduced contractility (EF ≤40%) → ↓CO → neurohormonal (RAAS/SNS) activation → volume overload & remodeling.
Signs & Symptoms
Dyspnea on exertion, orthopnea, PND, bilateral crackles, JVD, S3 gallop, peripheral edema.
Gold Standard Diagnosis
Echocardiography (assesses EF). BNP/NT-proBNP supports dx and tracks severity.
First-line Treatment
GDMT: ARNI (or ACEi/ARB) + beta-blocker + MRA + SGLT2 inhibitor; loop diuretic for congestion.
Drug cardsLisinoprilCarvedilolSpironolactoneEmpagliflozinFurosemide
High-Yield Pearl

The 4 pillars (ARNI, BB, MRA, SGLT2i) reduce mortality. Diuretics treat symptoms, not mortality.

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Sources

Reviewed September 2026
  1. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure — AHA/ACC/HFSA, 2022
  2. StatPearls: Heart Failure — NCBI Bookshelf / StatPearls, 2025
  3. StatPearls: Heart Failure — Table 2, Classification of HF by LVEF — NCBI Bookshelf / StatPearls, 2025

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