The Curbsiders Internal Medicine Podcast REBOOT: #469 Inpatient Heart Failure
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Feb 9, 2026 Gurusher Panjrath, an advanced heart failure and transplant cardiologist who leads GWU’s Heart Failure and Mechanical Circulatory Support Program, walks through inpatient heart failure care. He covers POCUS and echo timing. Practical diuretic strategies and adjuncts. Starting SGLT2s and the four-pillars approach. Managing cardiogenic shock, right heart cath indications, and safe discharge planning.
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Echo For New HF; Repeat Only If Useful
- Obtain an echocardiogram in any patient with suspected new heart failure to define EF, structure, and guide therapy.
- Do not repeat routine echos during an admission unless results will change management (e.g., hemodynamic change, valve assessment).
Pragmatic Sodium And Fluid Limits
- Moderate sodium restriction (about 2 g/day) and reasonable fluid limits (48–64 oz/day) are pragmatic in acute HF, but overly bland diets risk poor intake.
- Tailor restrictions to nutrition needs and avoid unnecessary severe fluid restriction in most patients.
Start Low Doses Of All Four Pillars
- Aim to start the four foundational HF therapies (SGLT2, ARNI/ACE/ARB, beta‑blocker, MRA) early when tolerated, tailoring sequence to BP and renal function.
- Begin low doses of all pillars rather than high dose of a single agent, then uptitrate.