CHF Flashcards
symptoms of CHF
fluid overload
SOB
Edema
without symptoms of HF and without structural damage is which class
Class A ACC
structural damage with elevated biomarkers without symptoms of HF
class B
NYHA 1
structural and functional heart damage with SOB, fatigue, and reduced exercise tolerance
Stage C or NYHA 1 2 3
how to differentiate NYHA class 1 2 3
class 1 = no limitation in physical activity
class 2 = slight limitation in physical activity walking up the stairs
class 3 = comfortable at rest but minimal exertion causes symptoms
what is a class D or 4 HF
advanced HF with severe symptoms
unable to carry physical activity without symptoms of HF or Symptoms at rest
lab biomarkers for HF
BNP <100
NT BNP <300
SOB
CO is CI is
stroke volume X HR
CO/BSA
Renin angio tensin-aldosterone system controls how
renin - Angiotensinogen to A1
A1-A2 by ACE
A2 causes vasoconstriction and release of aldosterone from adrenal gland and vasopressin from pituitary
aldosterone causes sodium and water retention and increases K excretion
vasopressin causes vasoconstriction and water retention
non pharm for HF
Sodium < 1500
restrict fluid 1.5-2L
BMI <30
exercise
if increase in weight by 2-4 lbs in one day or 3-5lbs in a week call doc
what are some natural product to help with HF
fish oil
Co Q10
haw thorne
avoid ephedrine
what drugs can worsen HF
Fluid retention drugs, BP increasing or negative inotropic
DPP4 by increasing Ca
Immunosupressant
non DHP
antiarhythmatics class 1 agents
thiazolidinediones risk of edema
itraconazole
doxyrubicin, danurubicin
NSAIDS
alogliptin
procainamide
what are the ways body compensates for HF (decrease CO)
SNS- BB
RAAS- ACE/ARBs/Ara, Loop
Vasopressin- LOOP
Natriuretic peptides- sacubitril
Diogxin directly
ACE BB SGLT2 hydralazine - decrease risk of mortality
1st line for HF
ACE/ARB/ARNI
BB
loop-
2nd line for HF
ARA- must meet GFR and SCR
SGLT2- must meet GFR, with or without diabetes
Hydralazine or BIDIL- AA pts
ivabradine (corlanor)
additional meds for HF
Digoxin
vericiguat
loop diuretics in HF
1st line
excretion of NA,K,MG,water,CA
furosemide, bumetanide
toresemide
ethacrynic acid
** orthostatic hypotention
FTB 40, 20, 1
F IV to PO is 1:2
rest is 1:1
otoxicity
what medication should not be used with pts with angio edema and also teratogenic
ACE ARB
what medication is used to block neprelysin
Sacubutril
AE- teratogenic same as ARB, washout with ace fo 36 hours
risk of hyperkalemia
what BB are used for CHF
B-1 2 and Alpha 1 activity
B1 selective
metoprolol target dose 200mg daily
bisoprolol
non selective
carvedilol- with food twice daily
ARA- aldosterone receptor antagonists
spironolactone- gynecomastia target 25 daily or BID
eplerenone
BIDIL
hydralaazine /isosorbide dinitrate
** PE do not use with PDE5
SGLT2 in CHF
dapagliflozin or farxiga - Hfref
empaglaflozin or jardiance
GFR<30 do not use
digoxin
inhibits NA-K atpase pump increase CO
positive ionotrope
negative chrono trope
TI- 0.5-0.9
decrease dose 20-25% when switching from PO to IV
do not use in hypokal hypo mg and hypercalcemia
ivabradine
Corlanor
- disrupts SA node resulting in decrease HR
use when HR >70
Vericiguat
soluble guanylate cyclase stimulator
target dose of valsartan in CHF HPT
160mg BID
target dose of enalpri
1020mg PO BID
target dose of lisinopril
20-40mg PO DAILY
target dose of losartan
50-150mg daily
target dose for toprol
200mg daily
what meds improve mortality
ACE
BB
spironolactone
carvedilol moa
non selective B12 A1
can cause impotence
target dose carvedilol IR
<85kg 25mg BID
>85kg 50mg BID
ER= 80mg daily
what 3 BB improve cardiac function and benefits in CHF
metoprolol
bisoprolo
carvedilol
electrolytes that go down using loop
K
MG
Na
Cl
Ca
thiazide increase Ca
electrolytes that go up with loop
Hco3
UA
BG
TG
Cholesterol
