Clinical Treatment of HF Flashcards
1
Q
Major goals of HF therapy (6)
A
- Correction of the underlying cause of HF
- e.g. revascularize in case of ischemia
- Elimination of precipitating factors
- Reduction of congestion (fluid optimization is a major part of HF therapy)
- Improve flow (may be difficult to do medically)
- Modulate neurohormonal action
- Long-term stabilization, positive remodelling, increased survival.
- Optimization of cardiac function
2
Q
Major classes of medication for HF (4)
A
- diuretics
- vasodilators
- neurohormonal antagonists
- inotropes
3
Q
Function of diuretics in tx of HF
A
- reverse the sodium and fluid retention of HF
- fxn @ far end of the frank-starling curve, such that significant decreases in pressure produce minimal changes in stroke volume (and thus CO)
- symptoms of congestion can be reduced without major effects on blood flow
4
Q
Fxn of various types of vasodilators in tx of HF
A
- Vasodilators: arterial, venous, and pulmonary arterial vasodilation
- Arterial: ↓ LV afterload, ↓ cardiac work, ↓ mitral regurgitation
- Venous: ↓ preload
- Pulmonary: ↓ RV afterload
5
Q
Types of neurohormonal antagonsists
A
- ACE inhibitors
- Angiotensin receptor blockers (ARBs)
- Aldosterone receptor blockers
- Beta-blockers
6
Q
ACE inhibitors fxn in tx of HF (+side effects)
A
- block conversion of ATI to ATII→direct vasodilation, decreased aldosterone activation
- Side effects: hypotension, worsening renal failure, hyperkalemia, cough (kinin production), angioedema
7
Q
Angiotensin receptor blockers fxn in tx of HF
A
- blocks receptor of ATII→ equivalent to ACE -Is, but without cough.
8
Q
Aldosterone receptor blockers fxn in tx of HF
A
- block aldosterone action in kidney→↓sodium→diuretic
- anti-remodeling activity at the level of the heart
9
Q
Beta-blockers fxn in tx of HF (+side effects)
A
- antagonize effects of the sympathetic nervous system→↓chronotropy ↓inotropy (short term loss for long term gain)
- Side-effects: bronchoconstriction
10
Q
Fxn of Inotropes in tx of HF (& major types)
A
- administered via IV agents short term in the ICU to reverse shock (long term—worsen remodelling ↑mortality)
- Digoxin—K/Na exchanger
- Dobutamine—beta agonist
- Milrinone—PDEi (posphodiesterase inhibitor)
11
Q
Electrical therapies used for HF (2)
A
- defribrillators
- resynchronization
12
Q
Fxn of defribillators in tx of HF
A
- for patients with LVEF < 35% or with prior dangerous rhythms. Implanted.
- Abort sudden cardiac death from ventricular tachycardia/fibrillation.
13
Q
Fxn/procedure of resynchronization in tx of HF
A
- Left ventricular lead placed from the RA through the coronary sinus over the epicardium of the LV (3 leads: RA, RV coronary sinus/LV)
- For patients with QRS > 120 msec (bundle branch block)
- Cause the lateral wall and septal wall to contract together, which produces:
- More efficient contraction→↑stroke volume
- May also improve mitral valve function→↓regurgitation
14
Q
Advanced therapies for tx of HF
A
- Transplantation: shortage of organs.
- Mechanical support devices: often used as a bridge to transplantation or as a destination therapy.
- Hospice: palliative advanced therapy→paradigm shift from quantity to quality of life
15
Q
Therapy goals/Tx for Stage A HF
A
- Stage A: at risk for HF but without structural disease or symptoms
- Therapy goals: treat hypertension, smoking cessation, treat lipid disorders, regular exercise, discourage alcohol intake, drug use, control metabolic syndrome
- Drugs: ACEi or ARB in appropriate patients.
