B4.028 - Heart Failure Treatments Flashcards
what is the growth of HF population due to
improved management of cardiac disease
systolic cardiac dysfunction
impaired ability to eject blood
diastolic cardiac dysfunction
impaired ability of LV to fill with blood
clinically what is heart failure
inability to adequately supply blood to metabolizing body tissues
What is HFpEF
heart failure with preserved ejection fraction diastolic HF
which type of HF has had therapies shown to be effective
HFrEF
what is HFrEF
Heart failure with reduced ejection fraction Systolic HF
underlying causes of HF
- coronary artery disease 2. Hypertension 3. myocardial disease 4. valvular disease 5. pericardial disease
what are the types of Myocardial disease that can lead to HF
dilated infiltrative inflammatory hypertrophic stress cardiomyopathy
what are valvular diseases that can cause HF
aortic stenosis aortic regurgitation mitral stenosis mitral regurgitation
pericardial disease that can cause HF
tamponade constrictive pericarditis
describe the fundamental causes of HF
increased hemodynamic burden or impaired myocardial oxygen delivery triggers biochemical and physiological mechanisms that impact contractility and may promote vasoconstirtion and increased resistance, as well as sodium and fluid retnention
what are some systems that can be fundamental causes of HF
renin angiotensin system activation
sympathetic nervous system activation
remodeling due to myocardial changes
what are precipitating causes of HF
inappropriate reduction of therapy arrhythmias MI infection PE unrelated illness Drugs cardiac toxins severe stress
what is HF (type of condition)
syndrome
patients with asymptomatic LV dysfunction are 5x more likely to develop what
HF clinical syndrome
presentation of HF
decreased exercise tolerance manifestations of fluid retention discomfort at rest increased TPR
heart failure risk factors
HT coronary artery disease DM obesity smoking valvular heart disease
diastolic dysfunction risk factors
female older HT
is systolic or diastolic HF more common
systolic
what happens to PMI in HF
may be shifted left
describe characteristic age of people with diastolic and systolic HF
diastolic - elderly systolic - any ages, 50-70
typical sex of diastolic and systolic HF
diastolic - female systolic - male
left ventricular cavity size in diastolic and systolic HF
diastolic - usually normal, LVH systolic - usually dilated
which heart sound is associated with systolic and diastolic HF
diastolic - S4 systolic - S3
what are tests to run for HF Dx
ECG CXR Echo CMR Blood chemistry (BNP)
what can an echo tell you
EF Chamber sizes Wall thickness Regional wall motion abnormalities valve abnormalities doppler assessment of diastolic function
what is BNP
seen in acute heart failure increased hormone level with increased ventricular wall stress due to pressure/volume overload
what levels of BNP are needed for a diagnosis fo HF
<100 - acute HF unlikely >500 - acute HF likely
what are the classes of heart failure
class 1 - asymptomatic class 2 - symptoms with heavy exertion class 3 - symptoms with mild exertion class 4 - symptoms at rest
what are the determinants of stroke volume
preload contractility afterload heart rate cardiac output LV contraction, wall integrity, valve competence HR
what are the medical treatment options for Systolic HF
Vasodilators Beta blockers ACE Inhibitors Entresto Corlanor
what do vasodilators do in CHF
reduce preload and afterload
what do beta blockers do in SHF
reduce HR and sympathetic overactivity
what are the beta blockers for HF
carvedilol, bisoprolol, metoprolol succinate
what medications for SHF dont improve outcome but have a role in symptom management
digoxin - inotropic agents diuretics
what is stage A SHF and what do you treat with
High risk no symptoms preventative, lifestyle changes, risk factor reduction
what is stage B SHF and how do you treat
structural heart disease, no symptoms ACE inhibitors or ARBs in all patients; beta blockers in selected patients
what is stage C SHF and how do you treat
structural disease, previous or current symptoms ACE inhibitors and beta blockers in all
what is stage D SHF and how do you treat
refractory symptoms inotropes
describe stage A HF and what goals of treatment/treaments are
what is stage B HF and what are the goals of treatment/treatments
what is stage C HF and what are goals of treatment/treatments for it
what is stage D HF and what are goals of treatment/treatments for it
Describe stage A HF medical interventions
Stage B HF recommendations
Structural heart disease but without signs or symptoms of HF
Stage C nonpharma interventions
Also: continuous positive airway pressure (CPAP) for sleep apnea
Cardiac rehab
pharm therapy for stage C HFrEF
Beta blockers
Aldosterone antagonists
hydralazine and isosorbide dinitrate (vasodilators)
should you give calcium channel blockers to stage C HF paitents?
God NO
Describe the magnitute of benefit for Stage C HFrEF for ACE I, Beta blockers, aldosterone antagonists, hydralazine/nitrate
what are treatment options for HFpEF
what are device treatments for stage C HFrEF
ICD - uses electrical pulses or shocks to help control life-threatening arrhythmias, especially those than can cause sudden cardiac arrest/death
CRT - sequentally paces cardiac ventricles in a more synchronized and physiologic pattern
what are treatments for stage D HF
water restriction
inotropic support
mechanical circulatory support
LVAD
cardiac transplantation
what are the most recommended therapies for hospitalized HF patients
what are surgical/percutaneous/transcatheter interventional treatments of HF
CABG
PCI
aortic or mitral valve surgery
resection of ventricular aneurysm
