Cardiopulmonary: HF Flashcards

1
Q

examples of neurohormonal activation in HF

A

RAA stimulation

sympathetic stimulation

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2
Q

severity of HF disease is evaluated by

A

NY Heart Association functional classifications

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3
Q

NYHA classification of heart failure focuses on

A

activity

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4
Q

ACC/AHA heart failure stages focus on

A

structural changed

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5
Q

List the classes, I - IV, of NYHA Heart Failure

A

I-No symptoms c ordinary activity
II-Symptoms c ordinary activity
III-Symptoms c less than ordinary activity
IV-Symptoms at rest

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6
Q

Higher number of letter of class/stage of HF usually means

A

more drugs used concurrently

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7
Q

Treatment choice for HF is usually based on

A

Stages/Classes of HF according to NYHA and sometimes ACC/AHA

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8
Q

Compensation derangement: ventricles

A

ventricular hypertrophy

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9
Q

compensation derangement: neurohormal mechanisms

A
  • adrenergic system
  • RAAS
  • secretion of ADH and BNP

They go on overdrive and need to be quieted down.

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10
Q

Natriuretic peptides derangements

A

Normally, these cause you to urinate out sodium. When deranged like in the setting of HF, this may not happen.

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11
Q

Remodeling -> fluid retention -> increased demand

A

LV becomes floppy, weak, and less effective. Therefore you will have major fluid overload and then derangement of compensation.

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12
Q

Left sided heart failure vs Right sided

A

Left - lung driven

Right - systemic driven

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13
Q

What is the major cause for symptoms of left sided HF?

A

Pulmonary congestion

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14
Q

What is the major cause for symptoms of R sided HF?

A

Systemic venous congestion

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15
Q

High output vs low output HF

A

less frequent, seen in thyroid disease

demand vs pump function

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16
Q

HFrEF

A

HF with reduced EF ( <40%)

Systolic

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17
Q

HFpEF

A

HF with preserved EF (~50%)

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18
Q

Which would you treat more aggressively? Systolic or Diastolic?

A

Diastolic - in systolic a lot of damage is already done and EF is reduced.

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19
Q

Non pharm tx of HF

A

lifestyle modification to prevent initial and recurrent injury, progression.

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20
Q

Purpose of pharm intervention for HF

A

to prevent progression in symptomatic and asymptomatic patients c HF

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21
Q

Digoxin is a

A

cardiac glycoside

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22
Q

Digoxin is used for its

A

decreased activation of neurohormonal systems

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23
Q

Digoxin is used more for its _____ properties rather than its ______ property

A

neurohormonal; positive ionotropic action

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24
Q

Digoxin and mortality

A

Will increase QoL and reduce symptoms, will not decrease mortality

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25
Q

digoxin:antacids

A

digoxin needs an acidic environment to work properly

26
Q

digoxin:St. John’s Wort

A

SJW is an enzyme inducer

27
Q

Dig levels for CHF

A

0.5 - 0.8

28
Q

Dig levels for A-Fib

A

0.8 - 1.2

29
Q

K should be kept at __ when on digoxin

A

4.0

30
Q

Mag should be kept at __ while on digoxin

A

2.0

31
Q

Downside of using digoxin

A

Need frequent labwork

32
Q

Dr. Carey says to keep digoxin level between

A

0.5 - 1

33
Q

Why are aldosterone antagonists used in HF

A

Helps with RAA action, not necessarily used for its diuretic properties.

34
Q

CCBs in HF - NDHPs or DHPs ?

A

DHP

35
Q

Why aren’t NDHP CCBs used in HF?

A

because of risk for heart block

36
Q

Vasodilator combo drug used for African American patients in HF

A

BiDil - hydralazine+ISO DN

37
Q

Hydralazine/Iso DN use is limited to

A

patients who cannot take ACE/ARB bc of ineffectiveness or adverse reactions

38
Q

Why do we limit the use of hydralazine/ISODN?

A

Compliance issues due to very high pill burden and significant adverse effects

39
Q

BiDil (hydralazine/ISODN) theorized MoA?

A
  • ISDN exerts dilatory effects by releasing nitric oxide at BV wall
  • Hydralazine may also lessen tolerance to nitrates, so nitric oxide remains active longer.
40
Q

ISODN’s dilatory effects by releasing nitric oxide at the BV wall wears off after about

A

12 hours

41
Q

natriuresis

A

urinating of sodium

42
Q

adding hydralazine to ISO DN

A

extends ISODN’s 12 hour dilatory effect

43
Q

Sacubitril/Valsartan (Entresto) is a combo of

A

ARB and neprilysin inhibitor

44
Q

ACC/AHA HF guideline: in NYHA Stage II-III HFrEF patients NOT tolerating ACE or ARB….

A

replacement with ARB/NI is recommended to decrease morb/mort

45
Q

When do you use an ARB in HF?

A

when you can’t tolerate or when you fail an ACE

46
Q

BNP responds to

A

stretch of the heart

47
Q

normal BNP

A

hundreds

48
Q

abnormal BNP

A

thousands

49
Q

high BNP initial treatment

A

diurese

50
Q

dig levels can start to be dangerous after

A

1

51
Q

ISDN function

A

vasodilator

decreases preload

52
Q

hydralazine function

A

arteriodilator, decreases afterload

53
Q

why are hydral and ISODN given together?

A

competing qualities - one vasodilator (hydralazine), the other then keeps the vessels open (ISO DN via nitric oxide)

54
Q

hydralazine plus iso dn does what

A

keeps the vessels open longer.

55
Q

nitrate holiday

A

12 hours on 12 hours off. give vessels a chance to respond.

56
Q

Hydral/iso dn should be given at what freq?

A

TID or BID. Not Q8

57
Q

digoxin level for CHF vs for A fib

A

CHF: .5-.8
Afib: .8-1.2

58
Q

ISO DN vs MN

A

dinatrate needs more frequent dosing. MN has longer half life, better for decreasing pill burden.

59
Q

Summary of tx for HF (6)

A
ACE
diuretic
B blockers
Digoxin
Vasodilators/ISDN (if no ACEs)
CCBs
60
Q

DHP CCB in HF

A

only if every other agent is maxed out and we need more after load reduction to decrease the bp (and if not in decompensated)