Acute and Chronic HF Flashcards
What is the main valvular problem that may come with CHF
Mitral valve regurgitation
What are the common causes of HFpEF
Chronic HTN, Aortic stenosis
What are the common causes of HFrEF
MI, dilated cardiomyopathy, myocarditis
What are the 3 cardinal symptoms of HF
Dyspnoea especially on exertion, fatigue, oedema
What are the 4 pillars of drug for CHF
- SGLT2 inhibitor eg empaglifozin
- Beta blockers
- ACEi/ARB/ ARNI
- MRA eg spironolactone
What is the acceptable increase of creatinine and potassium after starting ACEi
up to 50% above baseline and K as long as it is below 5.5
which 4 beta blockers can help HF
- Bisoprolol
- Carvedilol
- Metoprolol
- Nebivolol
when is ivabradine appropriate for CHF
when patients are symptomatic with LVEF <35% and resting heart rate >70 despite maximum dose or if unable to tolerate beta blocker
When is hydralazine and ISDN considered in CHF
symptomatic HFrEF and cannot tolerate ACEi, ARB or ARNI
What are some drugs that are contraindicated in CHF
Non-dihydropyridine CCB, NSAIDs, COX 2 inhibitors
What are the indications of CRT
-Patients who are persistently symptomatic in in NYHA Class III & ambulatory class IV OR in NYHA Class II heart failure despite maximal medical therapy WITH widened QRS on ECG (QRS duration ≥120ms if LBBB, ≥150ms if non-LBBB)
-Only if they are expected to survive >1 year
Indications of ICD
-Those who have recovered from ventricular arrythmia causing hemodynamic instability
-Symptomatic HF (class II-III) of an ischemic aetiology, LVEF <35% despite more than 3 months of OMT
