B - 14. Drugs used for treatment of heart failure I: Drugs decreasing the load on the heart. Drugs of acute cardiac failure. Pharmacotherapy of chronic heart failure

Question 1

NYHA classes of heart failure

Answer 1

Symptoms at

1. extreme exertion
2. moderate exertion
3. mild exertion
4. at rest

Question 2

Drugs for all classes (chronic)

Answer 2

Beta blockers (do NOT give in acute HF)
ACEi (ARBs if patient gets chronic cough)

Question 3

Drugs for NYHA II

Answer 3

Loop diuretics or thiazide diuretics

+ drugs for all classes

Question 4

Drugs for NYHA III

Answer 4

Aldosterone antagonists (spirolactone)
or
Vasodialators
+ drugs for all lower classes

Question 5

Drugs for NYHA IV

Answer 5

Positive inotropes 
(digoxin is contraindicated in hypertrophic obstructive cardiomyopathy)
\+ drugs for all lower classes

Patient should be transplanted asap

Question 6

All drugs for heart failure must be…

Answer 6

titrated from the lowest effective dose to the highest tolerable dose

Question 7

If patient suffer from ischemic HF

Answer 7

Aspirin and statins are added

Question 8

Acute HF

Answer 8

1. O2
   <90% - Oxygen given
   <80% - assisted ventilation
2. BP
   - severe hypotension -> IV inotropics like dobutamine