Car 5 - Treatment Of CHF Flashcards
A 76 y.o male patient complains of SOB after 2-3 mins of excercise. P.E. Shows mild pedal edema. His lungs are clear. Echocardiogram’ shows an estimated left ventricular ejection fraction of 25% w/o valvular dysfunction. What drug classes are proven to reduce mortality in this patient?
ACE inhibitors. ARBs. Aldosterone antagonists. Certain beta-blockers.
Which classes of drugs are proven to improve survival and reduce hospitalizations in chronic CHF?
ACE inhibitors. ARBs. Aldosterone antagonists. Certain beta-blockers.
Which classes of drugs used only for symptomatic relief in chronic CHF?
Diuretics. Digoxin. Vasodilators.
What drugs can combat/reduce activation of the RAAS in CHF patients?
ACE inhibitors and ARBs (block the action of angiotensin). Aldosterone antagonists (Block the effects of increased aldosterone secretion).
What drugs can be used to combat/reduce increased sympathetic activity in CHF patients?
Certain beta-blockers: Metoprolol, Carvedilol, Bisoprolol. Vasodilators.
When do we use beta blockers in patients w/ CHF?
Never use beta blockers in decompensated CHF. Use in chronic compensated CHF to control the negative effects of increased sympathetic activity.
What do we use to combat/reduce pump failure in CHF patients?
Digoxin: it is a positive inotrope that increases contractility and increases CO. (Reduces hospitalizations and improves excercise tolerance but it does not improve survival.
What is the physiology of heart contraction and how does Digoxin work?
There are three pumps in myocytes relevant to heart contraction: Ca pump, Ca/Na pump, Na/K pump. Ca enters the cell thru Ca pump. Ca leaves the cell in exchange for Na thru Ca/Na pump. Na leaves the cells for K thru the Na/K ATPase. Digoxin blocks the Na/K ATPase, leaving more Na in the cell, decreasing Ca/Na pump, leaving more Ca in the cell: more Ca means more contractility.
What are two uses of Digoxin (Digitalis)?
Chronic CHF. Control the heart rate in A-fib (decreases conduction thru the AV node).
What are the toxicities from Digoxin?
Cholinergic effects (vomiting, diarrhea). Blurry yellow vision. EKG abnormalities (Bradycardia). Toxicity more likely in patients with renal failure (digoxin excreted renaly), hypokalemia.
What is the treatment for Digoxin toxicity?
Correct any hypokalemia. Magnesium. Anti-digoxin Ab fragments: if not available give atropine for bradycardia. Temporary pacemaker.
What is the treatment of Acute CHF?
[NO LIP] Nitrates. Oxygen (only hypoxic). Loop diuretics. Inotropic drugs. Positioning (sit the patient up).
