Chronic Heart Failure Flashcards
When does heart failure occur?
when the heart is unable to supply the body sufficient oxygen-rich blood due to inability to fill or eject blood via the ventricle
Difference between ischemic and non-ischemic heart failure
ischemic: due to decreased blood supply (post-MI)
non-ischemic: due to long-standing uncontrolled blood pressure
What does an EF <40% represent?
systolic dysfunction (contraction) or reduced ejection fraction
When is it HFpEF
EF >/= 50% Car
At which ACC and NYHA staging/classification is a patient experiencing symptoms of HF and some structural heart disease
ACC: C
NYHA: II
What lab elevation can indication systolic heart failure
elevated BNP (>100)
Equation for cardiac output
CO = HR x SV
Equation for CI
CI = CO / BSA
How does the body compensate for a HFrEF or low cardiac output state?
activates neurohormonal pathways to increase blood volume and increase force/speed of contractions
temporarily increases CO but leads to cardiac remodeling
Why is RAAS activated in HF
the natriuretic peptides that balance the system are insufficent
Describe RAAS/Vasopressin activation
Renin converts angiotensinogen to Ang I
Ang I converted to Ang II by ACE
Ang II causes vasoconstriction and aldosterone and vasopressin release from the adrenal and pituitary gland respectively
Aldosterone prompts sodium and water retenion
Vasopressin causes vasoconstriction and water retention
What drugs can worsen HF symptoms?
DI NATION DDP4 inhibitors (gliptin) Immunosuppressants Non-DHP CCBs Antiarrhythmics Thiazolidinediones (glitazone) Itraconazole Oncology drugs NSAIDS
Treatment combo in HF
ACEi or ARB (entresto)+ Beta block + Loop
aldosterone antagonists are added next
How does a BB work in HF
it interferes with SNS activation by preventing increased HR and contractility (inotropic effects)
How does ACEi/ARBS work in HF
Prevent RAAS activation and thus fluid retention and vasoconstriction (stop the increased pre and afterload)
How do loops work in HF
prevents fluid retention
How does sacubitril work in HF
upregulates natriuetic peptides to balance out the overactivation of the SNS and RAAS
How does digoxin work in HF
provides an increase in CO to prevent overcompensation and thus improves symptoms and reduces hospitalizations
which HF drugs have mortality benefits?
ACEi, ARBs, Entresto, beta blockers
which HF drugs do not have a mortality benefit
loops, digoxin (symptom management)
Allergy warning in loop diuretics
sulfa!
Loop equivalent dosing
Furosemide 40mg = torsemide 20mg = bumetidine 1 mg = ethacrynic acid 50mg
Furosemide IV:PO
1:2
What can be added on if patient has insufficent response to a loop?
thiazide like metolazone!
Which beta blockers can be used in HF
one’s without ISA
metoprolol succinate
carvedilol
bisoprolol
CI for digoxin
ventricular fibraliation
Which potassium dosage form should not be cut in half
K-Tab, Klor-Con
* but Klor-Con M can!
