253 - Heart Failure : Management Flashcards
What is the goal of treating HFpEF (3)?
- Controlling congestion
- Stabilizing HR and BP
- Improving exercise tolerance
What is the most effective type of treatment to improve HFpEF symptoms?
Decreasing BP
How does ARB influence patient management?
Reduce hospitalizations, but does not influence mortality
Give 2 examples for ARB drugs
- Candesartan
2. Irbesartan
What may lead to ADHF (Acute Decompensated HF) (6)?
- Iatrogenic (NSAID)
- Stimulating drugs for cold/flu
- Licorice/Ginseng
- Infection
- PE
- Arrhythmias
What are the lab parameters linked to poor results (4)?
- BUN > 43
- BP < 115
- Creatinine > 2.75
- Troponin increase
How will you relieve congestion?
Diuretic until euvolemic state
What is the cardiorenal syndrome?
The relationship between cardiac and renal dysfunction- the damage of one organ when treating the other
What is the effect of long term usage of diuretics (2)?
- Decrease GFR
2. Worsening of cardiorenal syndrome ]
How will you improve patients until definitive treatment?
Inotropic treatment or circulatory support showed improvement of renal function in the short run
What is ultrafiltration?
Invasive technique to remove fluids without effecting the electrolytes in the serum
When will we use UF?
When treatment with diuretics is non responsive
What does the vascular therapy include?
Vasodilatation:
- Nitrates (nitroprusside, nesiritide)
- Serelaxin
List 2 inotropic drugs?
- Dobutamine
2. Phosphodiesterase 3 blockers (Milrinone)
What is the mechanism of inotropic therapy (4)?
- > Increase in intracellular calcium
- > Increase in CO
- > Improves perfusion
- > Reduce congestion
What are the risks in inotropic drugs?
Increases mortality in the long run
When will you use inotropic drugs (2)?
- Therapeutic bridge towards definitive treatment (LVAD/Heart transplantation)
- Palliation
Name two inotropic drugs
- Dobutamine
2. Milrinone
What is the leading diuretic drug?
Furosemide
What are the leading drug groups improving prognosis of HFrEF patients?
- RAAS
2. Beta blocker
What is the first line in HFrEF treatment?
BB+ACEI or BB+ARB or ACEI+ARB or Hydralazine+ nitrates
Name 3 BB drugs for HFrEF treatment
- Carvedilol
- Bisoprolol
- Metoprolol
What is the second line in HFrEF treatment?
Aldosterone antagonist:
Eplerenone or Spironolactone
Name 3 ACEI drugs
- Lisinopril
- Enalapril
- Captopril
Name 3 ARB drugs
- Losartan
- Valsartan
- Candesartan
Name an ARNI (Angiotensin Receptor Neprilysin Inhibitor) drug
Sacubitril-valsartan
When will you prescribe heart rate modification drug such as Ivabradine for HFrEF patient?
Patients under ACEI+ BB+ mineralocorticoid receptor agonist AND HR>70 AND symptomatic
Which patients will be treated with digoxin for HFrEF?
Digoxin is indicated for patients who are still symptomatic under full treatment
Name 2 CCB drugs
- Amlodipine
2. Felodipine
When will you prescribe CCB for HFrEF?
To decrease BP
- Do not influence mortality/morbidity/life quality
- Never use first gen drugs (Verapamil/ diltiazem)
Which patients are eligible for ICD
- Post SCD
- EF<35% AND NYHA 2-3
- EF<30%