Chronic HF

Question 1

Etiologies of HF

Answer 1

-Arrhythmias
-Myocarditis
-IHD
-Metabolic (dia, thy, obe)
-HTN

Question 2

SX

Answer 2

-Dyspnea, cough, orthopnea
-Abdominal swelling, cramps
-Weight gain, swelling in feet/ankles
-Confusion, cold skin

Question 3

EF Calculation

Answer 3

EF = LV EDV - LV ESV / LV EDV

Question 4

Non-Pharmacological

Answer 4

-Exercise, weigh daily
-Immunizations
-Salt <= 2 g/d, fluids < 2 L/d
-Avoid NSAIDS/alcohol/tobacco/nonDHPs

Question 5

ACEI

Answer 5

-Ramipril 10 QD
-Enalapril 10-20 BID
-Lisinopril 20-40 QD
-Captopril 50 TID

AE: hyperkalemia, cough, angioedema, AKI, hypotension (CAKAH)

CI: pregnancy, hx of angioedema

Question 6

ARB

Answer 6

-Losartan 50-150 QD
-Valsartan 160 BID
-Candesartan 32 QD

AE: hyperkalemia, angioedema, AKI, hypotension

CI: pregnancy, hx of angioedema with an ARB

Question 7

ARNI

Answer 7

ARNI is preferred
-Sacubitril/Valsartan 97/103 BID

AE: hyperkalemia, angioedema, AKI, hypotension

CI: pregnancy, hx of angioedema with ACEI/ARB

Question 8

Transitioning from ACEI/ARB to ARNI

Answer 8

• Low doses (<10mg lisinopril or <160mg valsartan) = start on Entresto 24/26
• High doses (>10mg lisinopril or >160mg valsartan) = start on Entresto 49/51

Question 9

MRAs

Answer 9

-Eplerenone 50 QD
-Spironolacatone 25-50 QD

AE:
-High K
-Low Na
-Gynecomastia (S)
-Dysmenorrhea (S)
-Dehydration

CI:
-S = pregnancy, GFR<30, Scr > 2/2.5, K 5+
-E = CrCl < 30, K 5.5+ (also has DDIs: CYP)

Question 10

Beta Blockers

Answer 10

-Bisoprolol 10
-Carvedilol 25-50 (CR is 80)
-Metoprolol Succinate 200

BHAD CAF

AE: brady, fatigue, drowsy, hypotension, can worsen congestive sx if not euvolemic

CI: acute decomp HR, active airway disease

Question 11

SGLT2i

Answer 11

-Dapa 10
-Empa 10
-Sota 200

AE: UTI, keotacidosis, dehydration

CI: recurrent UTIs (1-2 is ok)

Do not start dapa if GFR<25 (can continue if decreases to 25)

Question 12

Additional: Diuretics

Answer 12

Just treat sx (not help HF)

AE: low electrolytes, dehydration, AKI, alkalosis, ototoxicity

CI: sulfa (OK to use EA)

Overcome resistance by + thiazide = metolazone 30 min before loop

Question 13

Hydralazine/Isosorbide

Answer 13

Patients who are black and on optimal therapy or patients intolerant to ACEi/ARB/ARNI

LHARP

AE: hypotension, reflex tachy, headache, lupus

DDI: PDE5i

Question 14

Digoxin

Answer 14

IBW

Goal 0.5-0.9

If you give 250 mcg and level is 1.2, cut the dose in half and you would expect a level of 0.6

Question 15

Ivabradine

Answer 15

Pts on max tolerated BB with SR and HR 70+