CHF Cases- Leah (3)*

Question 1

Three BBers approved for treatment of heart failure

Answer 1

Metoprolol
Carvediliol
Bisoprolol

Question 2

How do ACEi/ARBs effect potassium levels?

Answer 2

They INCREASE K+ by blocking aldosterone

Question 3

What is an acceptable increase in creatinine for patients taking ACEi’s?

Answer 3

25% increase in creatinine; if higher- stop medication

Question 4

When is spirinolactone contraindicated?

Answer 4

If potassium > 4.5 meq/L

Question 5

If patients cannot take ACEi/ARBs, what is a good substitute? (2)

Answer 5

1. Hydrazine
   - Arterial dilator
2. ISDN
   - Venous dilator
   * Often used in African Americans who do not tolerate ACEi/ARBs

Question 6

What is the difference between CHF and acute heart failure?

What causes acute HF?

Answer 6

Acute= person with CHF that is in an unstable condition

• Induced by poor diet/poor medication compliance/ worsening heart failure

Question 7

Why aren’t ACEi/ARBs/BB good in acute heart failure?

Answer 7

They are good for decreasing mortality but they do not relieve conditions Assc with acute heart failure.

Question 8

Most common diuretics used in CHF?

Answer 8

Loop Diuretics, most potent

Usually furosemide, sometimes torsemide

Question 9

Important difference between furosemide and torsemide?

Answer 9

1. Furosemide has a varying bioavailability in different patients
   (Amount abosrbed may be anywhere from 10-80-%)
2. Torsemide has bioavailability of 90% in most all patients. More predictable.

“torsemide is trustworthy”

Question 10

Patients who have LV dysfunction/ CHF with low EF should be on what three classes of drugs?

Answer 10

• ACEi
• BBers
• Diuretics

(ACEi + BB most important according to clinician, ACEi and diuretic most important according to article.)
*Diuretics = symptom control, not mortality control

Question 11

When do you start a patient on BBers/ARBs/ACEi after new onset CHF/ acute CHF?

Answer 11

Once dry weight is achieved (once edema is gone)

Question 12

Most common cause of death in heart failure?

Answer 12

Arrhythmias

V tach/ V fib

Question 13

Intervention for cardiac arrest?

Answer 13

1. Check pulse
2. CPR if no pulse
3. Defibrillate ASAP

Question 14

What are ICDs used to treat?

Answer 14

V tach/ potentially lethal arrhythmias

Question 15

When do you give a CHF patient ICD?

Answer 15

Patients whose EF is less than 35% after attempting to control with medications

Question 16

Most common causes CHF? (2)

Answer 16

HTN; CAD

Question 17

Where does BNP come from?

Answer 17

DISCOVERED in brain; comes from ventricles; same activity as ANP.

Question 18

Describe the 4 classes of heart failure

Answer 18

1. Asymptomatic
2. Symptomatic with ^^^^^^ activity. (Running a 5k?)
3. Symptomatic with mild activity(walking up flight of stairs)
4. Sick. In bed.

Question 19

Acceptable (dose of digoxin? Card got cut off!)

Answer 19

0.125 mg.
don’t go higher.
Digoxin doesn’t decrease mortality.
Does decrease hospital admissions.

Question 20

Minimum effective dose metoprolol:

Answer 20

> 100 mg

Question 21

Most important heart failure consideration?

Answer 21

Adjust Meds AND doses.

Question 22

Only drug that increases EF?

Answer 22

B blockers

Question 23

Drugs (3) that decrease mortality in CHF:

Answer 23

1. *ACEi’s (or ISDN + Hydrazine in AA patients)
2. *B Blockers
3. Spironolactone (when added to ACE + initial diuretic regimen)

*Probably statins too, but I don’t think they were mentioned here?