Contraindications for Heart Failure with Ejection Fraction of 44%
With an ejection fraction of 44%, you should avoid several medications and treatments that can worsen heart failure, particularly non-steroidal anti-inflammatory drugs (NSAIDs), certain calcium channel blockers, and class I antiarrhythmic agents.
Medications to Avoid
Absolutely Contraindicated:
Calcium channel blockers - specifically verapamil, diltiazem, and short-acting dihydropyridines are contraindicated as they have negative inotropic effects 1
- Verapamil is explicitly contraindicated in patients with severe left ventricular dysfunction and should be avoided in patients with any degree of ventricular dysfunction 2
Class I antiarrhythmic agents should be avoided due to their potential to worsen heart failure 1
NSAIDs and COX-2 inhibitors should be avoided as they:
- Cause sodium and water retention 1
- Are associated with increased risk of heart failure exacerbation 3
- Can increase risk of hospitalization for heart failure even in patients without prior heart failure history 4
- Are particularly problematic for patients with existing heart failure, with a 9.9-fold increased risk of relapse 5
Tricyclic antidepressants should be used with caution or avoided due to potential cardiac effects 1
Corticosteroids should be used with caution due to fluid retention properties 1
Lithium should be used with caution 1
Special Considerations for Your EF of 44%
With an ejection fraction of 44%, you fall into the category of heart failure with mildly reduced ejection fraction (HFmrEF) according to current guidelines 1, 6. This has specific implications:
- Your heart failure is in the "borderline" range between reduced and preserved ejection fraction
- You may benefit from similar medications as those with more reduced EF 1
- You should be particularly careful with medications that can worsen heart failure
Alcohol Consumption
- Moderate alcohol intake (one beer or 1-2 glasses of wine/day) is generally permitted unless you have alcoholic cardiomyopathy, in which case it is prohibited 1
Fluid Considerations
- If you have advanced heart failure, fluid restriction of 1.5-2 L/day is advised 1
- Sodium restriction is more important in advanced heart failure than in mild cases 1
Exercise Recommendations
- Exercise is beneficial and should be encouraged, but should be tailored to avoid inducing symptoms 1
- Exercise training programs are encouraged for stable patients in NYHA class II-III 1
Medication Management
When managing your medications, be aware that:
- ACE inhibitors are recommended for patients with EF <40-45% 1
- Beta-blockers are recommended for patients with left ventricular dysfunction 1
- Regular monitoring of renal function is essential when taking ACE inhibitors, particularly when dose is increased or when other medications affecting renal function are added 1
Common Pitfalls to Avoid
- Discontinuing heart failure medications without medical supervision - this can lead to rapid deterioration
- Self-medicating with over-the-counter NSAIDs - these can significantly worsen heart failure 3, 4
- Excessive fluid intake - can exacerbate heart failure symptoms
- Assuming all calcium channel blockers are equally risky - some are absolutely contraindicated while others may be used with caution
Remember that your medication regimen should be carefully monitored by your healthcare provider, with special attention to potential drug interactions and side effects that could worsen your heart failure.