CHF Flashcards
What are the two most common causes of left-sided CHF?
What about right-sided CHF?
- MI and long-standing HTN
- L-eft sided CHF and COPD
What are the EF cutoff’s for HFref, HFmrEF, and HFpEF?
What is the difference between HFref and HFpef?
HFref - >40%
HRmrEF - 41-49%
HFpEF - >50%
HFref is a problem with pumping out whereas HFpEF is a problem with filling up.
When would you get a N-terminal proBNP level?
When patients are on an ARNI. Because ARNI’s can increase BNP levels so monitoring BNP is not helpful in HF.
What is BNP?
It’s a natural hormone made by LV when it is failing as a compensatory effect because BNP has vasodilator and diuretic effect.
Sacubitril + valsartan
Brand
MOA
Contraindication
Entresto
Inhibit neprilysin - which is an enzyme that degrades BNP.
SBP<100 - because of high risk of hypotension
What are the three initial measures for ADHF?
What are 4 secondary measures and when would you implement them?
Keep O2 >90%
Seated posture
IV loop (bolus)
- If no response to loop - add IV Ntg
- If very low EF - add IV milrinone
- If severe HTN - add IV nitroprusside
- IF shock - add IV dobutamine/dopamine
What is initial GDMT for HFref?
- Loop
- RAAS
- BB - carvedilol, metoprolol, or bisoprolol
- SGLT2
- MRA
When would you use bidil in CHF?
Hydralazine + nitrste for black patient with NYHA 33-4
When would you use ivabradine?
Corlanor for PT with LVEF<35%, in sinus rhythm, on target BB, with HR>70
When you use digoxin in CHF?
For symptomatic PT with Ef<35% and NYHA 3-4. Just watch for electrolytes and renal function.
What are two contraindications to BB’s?
HR <50
Asthma - but NOT COPD
What are 4 contraindications to SGLTs?
T1DM
Predisposed to DKA
Hypotension
GFR<30
What are four levels that can increase risk of digoxin-induced arrhythmias?
HypoK+
HypoMg2+
HyperCa2+
Hypothyroidism
T/F: Digoxin helps with morbidity and mortality
False - it only helps with morbidity
Digoxin
Brand
MOA
Indication
Contraindication
ROA
Steady state
Lanoxin, Lanoxicaps, Digitek
Positive inotrope and negative chronotrope’
CHF, PSVT, Afib
HFpEF
IV, tabs, solution
7 days , up to 3 weeks for renal or elderly patients
What are 4 drugs that can increase digoxin levels?
Quinidine
Amiodarone
Verapamil
Clarithromycin
What are 4 medications that can increase digoxin levels because they decrease K+?
Steroids
Amphotericin B
Natural licorice
Diuretics
SAND
What are theraputic levels for digoxin in CHF and Afib?
What are symptoms of toxicity?
What do you do if digoxin toxicity?
What if you don’t have the preferred treatment for toxicity?
CHF - 0.5-0.8 ng/mL
Afib- 0.8-2 ng/mL
N/V, muscle weakness, yellow vision (xanthopsia)
Stop digoxin –> correct hypokaemia –> give digifab (40mg/vial)
Can give atropine IV 0.5-1mg Q3-5 minutes
How much K+ mEq increase blood level?
What is the max rate of peripheral infusion ?
10mEq will increase 0.1 mmol/dL
Max 10mEq/hour
Milrinone
MOA
Increase cardiac output as an inotrope and vasodilator
What are the max doses for the three BB’s used in CHF?
Carvedilol - 25mg BID with FOOD
Toprolol Xl - 200mg QD
Bisprolol - 10mg QD
Ivabradine
Brand
Indication
MOA
Dose
ADE
CI
Corlanor
Stable systolic HF with HR>70
Selective sinus node inhibitor
5-7.5mg BID with FOOD
Bradycardia, increase risk of Afib
ADHF, HR<60
What is the only diuretic that helps with mortality in CHF class 2-4?
Aldosterone antagonists
Which SGLT2i are approved for CHF?
Dapagliflozin and empagliflozin
Vericiguat
Brand
MOA
INdication
Dose
Box warning
Verquvo
sGC simulator –> increase cGMP –> vasodilation
Adjunct for symptomatic HFref already on optimized GDMT
10mg QD with food is the target
Pregnancy (fetal harm)
