ABC | Volume 112, Nº5, May 2019

Updated Updated Geriatric Cardiology Guidelines of the Brazilian Society of Cardiology – 2019 Arq Bras Cardiol. 2019; 112(5):649-705 Figure 1 – Diagnostic flowchart. HF: heart failure; HFpEF: heart failure with preserved ejection fraction; HFrEF: heart failure with reduced ejection fraction. < 50% HFrEF ≥ 50% HFpEF Surgimento de Gradiente sistólico dinâmico intraventricular Aspecto de cardiopatia isquêmica ELDERLY PATIENTS WITH CLINICAL SUSPICION OF HF EVALUATION WITH DOPPLER ECHOCARDIOGRAPHY Exclude: Cardiac sarcoidosis Cardiac amyloidosis (senile form) • Mitral regurgitation (degenerative/ischemic) • Severe aortic stenosis • Constrictive pericarditis • Pulmonary arterial hypertension • Congestive states (chronic/acute renal insufficiency and chronic anemia) EJECTION FRACTION ANALYSIS UNCLEAR CASES CARDIAC RESONANCE UNCLEAR CASES • Left atrial volume index • Left ventricular mass index • E/A ratio • E/E’ ratio • Pulmonary vein flow STRESS ECHOCARDIOGRAM • Evaluate aggravation of mitral regurgitation • Appearance of the dynamic systolic intraventricular gradient • Aspects of ischemic heart disease • Confirmation of diastolic dysfunction Available drugs, initial and target doses, dose adjustments, and safety in elderly patients Drugs Initial dose Maximum dose Dose adjustment for elderly patients Safety in elderly patients Captopril 6.25 mg 3×/day 50 mg 3×/day None Increase in orthostatic hypotension Take before bedtime Decrease diuretics Enalapril 2.5 mg 2×/day 10–20 mg 2×/day None More susceptible to renal dysfunction Lisinopril 2.5–5.0 mg 1×/day 20–40 mg 1×/day None Avoid use of NHAI drugs Perindopril 2.0 mg 1×/day 8,0–16 mg 1×/day None Ramipril 1.25–2.5 mg 1×/day 10 mg 1×/day Adjust according to renal function Candesartan 4.0–8.0 mg 1×/day 32 mg None, but elevated AUC and Cmax Similar to that of ACEI Losartan 25 mg 1×/day 50–100 mg None Valsartan 40 mg 2×/day 320 mg None Bisoprolol 1.25 mg 1×/day 10 mg 1×/day Water retention: - Monitor weight daily - Adjust diuretic dosage Risk of hypotension and bradycardia: - Start with a low dose and increase progressively - Adequate hydration Increased fatigue: - Improves over time - Consider comorbidities anemia 674