CV 21 Flashcards
what are the most common causes of HF
ischemic cardiomyopathy
- infarct (previous MI)
- ischemia (CCD)
non ischemic cardiomypathy
- HTN
- Dilated cardiomyopathy (alcohol, cocaine, genetic)
- valvular heart disease
- medications (chemotherapy)
cardinal signs and symptoms of HF
breathlessness, fatigue, peripheral edema
Stage A - at risk
at risk for HF without S/s of HF
- HTN, CVD, DM, fam history of cardiomyopathy
Stage B - Pre-HF
without current s/s but evidence of 1 of the following:
1. Structural Heart Disease
2. Abnormal Cardiac Function
3. Elevated natriuretic peptide levels or cardiac troponin in the setting cardiotoxins
Stage C - heart failure
with current S/S of HF,
Stage D - Advanced
Severe s/s of HF at rest, recurrent hospitalizations despite GDMT
What is the ejection fraction
amount of blood pumped out/amount of blood in chamber
HFrEF
HF with reduced ejection fraction (<= 40%)
HFmrEF
HF with mildly reduced EF (41-49%)
HFpEF
HF with preserved ejection fraction (EF >= 50%)
standard therapies HFrEF (MABS)
ARNI, ACEI, ARB
Beta-blocker
MRA
SGLT2i
ARNI compred to ACEI
more effective, but increased hypotension
two proven beta blockers reducing death in HFrEF
bisoprolol
Carvedilol
when are beta blockers contraindicated
low heart rate <60bpm
Contraindications of an MRA
eGFR <30
K>2.2mmol/L
common SE with MRA, specifically spironolactone
Gynecomastia
HYPERKALEMIA
do flozins work the same in pts with or without DM
yes
Flozins CI
Type 1 DM, on dialysis
do you need to titrate flozins
no! 10mg daily
Flozin SE
Yeast infections!
what do flozins do in terms of GFR
lower it, it is expected and not concerning
which drug causes the side effect sexual dysfunction
beta blockers
do a fluid assessment with which med
beta blockers, SGLT2i
Digoxin
decreases hospitalizations. Only used after all GDMT
Hydralazine indication + SE
Pts with HFrEF who are unable to toelrate an ACEARBARNI because of hyperkalemia, renal dysfunction or other CI.
Pts who are black after GDMT
Interacts with Phosphodiesterase 5 inhibitors
Ivabradine
HFrEF pts with GDMT max, resting HR of >70bpm
how long should a patient be on these therapies
generally. lifelong.
which medication reduce hospitalizations in HFpEF
SGLT2i (flozins)
which medication reduce hospitalizations in HFmrEF
flozins and MRA
do any of these medications prolong survival in HFpEF or HFmrEF
NO!!
