Acute heart failure, Medical T

Question 1

What is absolutely not to give in Acute HF

Answer 1

• no beta blockers ! because of its negative inotropic effect

Question 2

Steps of the T

Answer 2

• restore oxygenation and tissue perfusion
• monitor, ensure IV access
• position: sit/half-sit (45 degrees)
• symptom guided treatment
• etiology evaluation and causal treatement
• fluid control

Question 3

What to give in case of: stable decompensated CHF

Answer 3

• vasodilators, loop diuretics, + inotropes

Question 4

What to give in case of: cardiogenic shock

Answer 4

• fluid, inotropes, intubation, intra-aortic ballon conterpulsation (IABP)

Question 5

What to give in case of: Pulmonary oedema

Answer 5

• morphine, loop diuretics, vasodilators, inotropes

Question 6

What to give in case of: RHF

Answer 6

• fluid and ionotropes

Question 7

Name the inotropes/vasopressors:

Answer 7

• dobutamine, NE, DA, E, Phenylephrine, vasopressin

Question 8

Name the diuretics:

Answer 8

• loop diuretics: furosemide, bumetanide
• thiazide diuretics to inhibit reabsorption of Na and Cl: hydrochlorothiazide, metolazone, in combination with loop diuretics
• potassium sparring diuretics: amiloride, triamterene, to prevent hypokalemia

Question 9

Name the phosphodiesterase inhibitors:

Answer 9

• Milrinone, dipyridamole -> increases cardiac contraction, vasodilation

Question 10

Role of Digoxin

Answer 10

• controls supra ventricular arrhythmias including AF

Question 11

Name the vasodilators:

Answer 11

• nitrates, hydralazine, isosorbide

Question 12

Ca sensitizers:

Answer 12

• levosimendan

Question 13

State the different Neuro-hormonal agents used in acute HF

Answer 13

• ACEi -> ramipril, captopril, enalapril, fosinopril
• ARBS -> used in patients that can’t tolerate ACEi
• Aldosterone receptor antagonists -> sprironlactone

Question 14

Name the calcium channel blockers

Answer 14

• Amiopidine, felpidine, verapamil (in HTN and angina for vasodilation) can cause peripheral oedema

Question 15

Anticoagulants and antiplatelets, use

Answer 15

• indicated in HF due to underlying IHD (ischemic heart disease), or patients proven to have Left V thrombus/ large LV with risk for thrombus formation

Question 16

Management of Acute HF in the emergency department

Answer 16

• oxygen to improve tissue oxygenation
• intravenous morphine as an anxyolytic
• diuretic to reduce volume overload
• vasodilators to reduce afterload
• isotropes in low output states
• vasopressors to maintain/restore BP

Question 17

Overview of the different drugs

Answer 17

Diuretics: work to maintain euvolemia by increasing fluid excretion; these drugs improve symptoms, but do not decrease mortality, and in fact can be injurious to renal function. May include thiazide diuretics, loop diuretics. May be given orally, or by bolus dose IV or continuous IV infusion.

ACE Inhibitors:- block the conversion of angiotensin I to angiotensin II; decrease vasoconstriction, cardiomyocyte hypertrophy, aldosterone and vasopressin release; reduce hospitalizations and mortality

Angiotensin receptor blockers: block the effect of angiotensin II; have similar effects as the ACE inhibitors; reduce hospitalizations and mortality

Aldosterone antagonists: block the binding of aldosterone to its receptor; diminish sodium retention and cardiac fibrosis; reduce hospitalizations and mortality

Beta blockers: decrease arrhythmia, vasoconstriction, sodium retention, and renin release seen with activation of the sympathetic nervous system; reduce hospitalizations and mortality

Digoxin: inhibits Na+ export via the Na/K ATPase, promoting calcium retention and increased inotropy; reduces hospitalizations, but does not decrease mortality

Hydralazine and nitrates: improve overall survival in African Americans with moderate to severe heart failure symptoms who are already on optimal medical therapy