Cardiovascular Conditions: Chronic Heart Failure Flashcards
HFrEF has a EF of…..
< 40%
HFmrEF has EF of….
41%-49%
HFpEF has EF of…
> 50%H
HFimpEF is when EF….
goes from < 40% to > 40%, its improved
NYHA stage 1
no limitations on physical activity
ordinary physical activity doesnt cause symptoms of HF
NYHA stage 2
slight limitations on physical activity
comfortable at rest, but ordinary physical activity results in symptoms of HF
NYHA stage 3
Limitation of physical activity
Comfortable at rest, but minimal exertion causes symptoms of HF
NYHA stage 4
unable to carry on any physical activity without symptoms of HF or symptoms of HF at rest
NYHA stage 5
unable to carry on any physical activity without symptoms of HF or symptoms of HF at rest
Cardiac output =
Heart rate X Stroke Volume
Lifestyle management for HF patients
monitor weight daily
notify provider if weight up 2/4lbs in day or 3/5lbs in week
Guideline HFrEF treatments
ACE/ARB/ARNi
BB
Aldosterone receptor antagonist
SGLT2i
Loop diuretics
Add on: Hydralazine+ nitrate/Ivabradine/Digoxin
Entresto (Sacubitril/Valsartan) info
start 24/26 BID, target dose of 97/103 BID
Entresto boxed warning
Dont use if pregnant, can cause injury and death to developing fetus
Entreso CI
dont use within 36hrs of ACE
Dont use if hx of angioedema
Entresto notes
dont need washout when switching from an ARB
Which Beta-Blockers recommended in HF?
Bisoprolol
Carvedilol
Metoprolol succinate ER
Spironolactone vs Eplerenone MOA
Spiro = non selective, also blocks androgen and exhibits endocrine side effects
Epler = selective, doesnt exhibit endocrine side effects
Spironolactone/Eplerenone CI
Hyperkalemia
Severe renal impairment
Addisons disease
Spironolactone/Eplerenone warnings
Dont start for HF if K > 5, 5.5 for eplere
CrCl < 40
ScR < 2 = females, < 1.5 = males
Spironolactone side effects
Gynecomastia
Breast tenderness
impotence
SGLT2i for HF
Dapagliflozin = dont start if eGFR < 25ml
Empagliflozin = dont start if eGFR < 20ml
Loop diuretic conversions
Furosemide = 40mg : Torsemide = 20mg = Bumetanide = 1mg
Furosemide PO:IV
40mg PO = 20mg IV
Loop diuretic drug interactions
avoid NSAIDs
BiDil is for…
self identified black patients with NYHA class III/IV HF who are symptomatic despite optimal treatment with an ARNI/ACE/ARB/BB/ARA/SGLT2
used as add on
BiDil =
Hydralazine/Isosorbide Dinitrate
BiDil contraindications
Dont use with PDE-5i or riociguat
Ivabradine uses
doesn’t reduce mortality, but does reduce risk of hospitalizations
should be used if resting HR < 70 BPM, pts with Class 2/3 NYHA and HF < 35%
Digoxin MOA
inhibits NA-K-ATPase pump, causing inc CO and dec HR
Digoxin dosing
goal of < 1ng/mL in HF
Digoxin toxicity
N/V
Loss of appetite
Blurred/double vision
greenish-yellow halos
bradycardia
life threatening arrhythmias
Digoxin antidote
DigiFab
Digoxin dosing adjustments
CrCl < 50mL = dec dose
Dec dose 20%/25% when switching PO to IV
Digoxin drug interactions
reduce dose by 50% when starting amiodarone
Vericiguat Info
Boxed warning: dont use if pregnant
CI: dont use with riociguat
SE: Hypotension, anemia, dyspepsia
Potassium supplementation
Should be checked with drug dose changes
Check mag first before potassium, low mag can effect potassium
Which Klor-Con can be dissolved in water?
Klor-Con M
