Chapter 31: Chronic Heart Failure Flashcards
ACC/AHA Staging System (A)
A- at risk for development but without disease symptoms, structural heart disease or elevated biomarkers
ACC/AHA Staging System (B)
B- Pre-HF; structural heart disease, abnormal cardiac fx, elevated biomarkers, with without signs and symptoms
ACC/AHA Staging System (C)
CLINICAL DIAGNOSIS OF HF
C- structural and/or functional cardiac abnormality w/prior or current symptoms of HF
ACC/AHA Staging System (D)
D- advanced HF with severe symptoms, symptoms at rest or recurrent hospitalizations despite maximal tx
NYHA Functional Class (I)
I- no limitations of physical activity. Ordinary physical activity does not cause symptoms
NYHA Functional Class (II)
II- slight limitation of physical activity. Comfortable at rest but ordinary physical activity (walking up stairs) results in symptoms of HF
NYHA Functional Class (III)
III- marked limitation of physical activity. Comfortable at rest but minimal exertion (dressing) causes HF symptoms
NYHA Functional Class (IV)
IV- unable to carry on any physical activity without symptoms of HF or symptoms of HF at rest (SOB while sitting)
Labs/Bio-markers
Increased BNP
Increased NT-proBNP
Used to determine between cardiac and non-cardiac causes of dyspnea
Left-Sided Signs and Symptoms
- Orthopnea
- Paroxysmal nocturnal dyspnea (PND)
- Bibasilar rales (crackling lung sounds)
- S3 gallop
- Hypoperfusion (renal impairment and cool extremities)
General Signs and Symptoms
- Dyspnea
- Cough
- Fatigue, weakness
- Reduced exercise capacity
Right Sided Signs and Symptoms
- Peripheral edema
- Ascites
- Jugular venous distention
- Hepatojugular reflux (neck vein distention from pressure placed on the abdomen)
- Hepatomegaly (enlarged liver due to fluid congestion)
Cardiac Output (CO)
Is the volume of blood pumped by the heart in 1 minute
is determined by HR and SV
CO= HR x SV
Stroke Volume (SV)
The volume of blood ejected from the left ventricle during 1 complete heartbeat.
SV depends on preload, afterload, and contractility
Drugs that cause or worsen HF
Drug Information NATION
D- DPP4i’s (alogliptin, saxagliptin)
I- Immunosuppressants (TNF inhibitors [adalimumab, enteracept] and interferons
N- Non-DHP CCBs (dilt and verapamil in systolic HF)
A- Antiarrhythmics (Class I agents [quinidine, flecainide] and dronedarone
T- TZDs (increased risk of edema)
I- Itraconazole
O- Oncology drugs (anthracyclines; doxorubicin, daunorubicin)
N- NSAIDs (excluding celecoxib)
Initial Medications (recommended in all patients without CIs)
- ACEi, ARB, or ARNI: decreased mortality in HFrEF, ARNI preferred
- BBs: controlling HR and reducing arrhythmia risk, decreasing mortality
- Loop diuretics: reduce blood volume which reduces edema and congestion
Secondary Medications (add-on in select patients)
- Aldosterone receptor antagonists (ARAs): decrease morbidity and mortality in NYHA class II-IV, added diuresis
- SGLT2i’s: decease morbidity and mortality in NYHA class II-IV must meet eGFR criterria
- Hydralazine and nitrates (Bidil): decrease morbidity and mortality in black patients with NYHA class III-IV when added to ace/arb and bb, or other patients who cannot tolerate ace/arb
- Ivabradine (Corlanor): decrease risk of hospitalization in patients with stable NYHA class II-III
Additional Medications
- Digoxin: provides small increase in CO, improves symptoms and decreases cardiac hospitalizations
- Vericiguat (soluble guanylate cyclase stimulator): decrease risk of hospitalizations and CV death after HF hospitalization or need for IV diuretics (not yet included in tx guidelines)
Loop diuretics dose conversion
"Fat Tina Bought Eggs" F-furosemide 40 = T- torsemide 20mg = B- bumetanide 1mg = E- ethacrynic acid 50mg
Furosemide IV:PO ratio
1:2
furosemide 20mg IV: furosemide 40mg PO
Target Dose for Enalapril
Enalapril 10-20mg po bid
Target Dose for Lisinopril
Lisinopril 20-40mg qd
Target Dose for Quinapril
Quinapril 20mg bid
Target Dose for Ramipril
Ramipril 10mg qd
