In episode of #209 of CardioNerds: A Cardiology Podcast, Drs. Karan Desai, Natalie Stokes, and Tiffany Dong join Dr. Randall Starling to discuss guideline-directed medical therapy (GDMT) through real cases. In one case, a man with genetic cardiomyopathy and heart failure with reduced ejection fraction (HFrEF) experienced worsening symptoms. He was treated with Sacubitril-Valsartan and Eplerenone after presenting with high blood pressure and poor heart function. The case highlights the importance of continuing beta blockers unless contraindicated and careful titration of GDMT to improve clinical outcomes.

Another case involves a 43-year-old with familial dilated cardiomyopathy and a ventricular assist device (VAD) who presented with low flow alarms. After diagnosing outflow graft occlusion and assessing heart function, his VAD was decommissioned. He struggled with hypotension on Sacubitril-Valsartan but was managed with carvedilol and lisinopril, later titrated to optimal doses. This case underscores the importance of differential diagnosis for VAD alarms, predictors for ejection fraction recovery, and the need to continue GDMT indefinitely in patients with heart failure recovery to prevent relapse.

Reference: 209. CardioNerds Rounds: Challenging Cases – Modern Guideline Directed Therapy in Heart Failure with Dr. Randall Starling. Accessed June 5, 2024. https://www.medicalnewstoday.com/articles/plant-based-low-sugar-diet-linked-to-lower-heart-failure-risk-in-large-study