Day 5 Heart Failure Flashcards
What are the hallmark symptoms of heart failure?
What is the difference between HFrEF and HFpEF?
What is the most important modifiable risk factor for heart failure?
Shortness of breath, fatigue, swelling
R=reduced and P= preserved.
Hypertension
What does chronic exposure to angiotensin 2 cause?
What does chronic exposure to AVP cause?
What does chronic exposure to aldosterone cause?
Is BNP good or bad?
Hypertrophy and remodeling
hypertrophy, remodeling, collagen deposits
Cardiac fibrosis, hypertrophy, endothelial dysfunction
Good
What happens in systolic dysfunction?
What happens in diastolic dysfunction?
What is NYHA-FC 1 classification?
decrease in the contractile function of the heart, normally caused by loss of mass (MI) but also hypertension, HFrEF.
imparied ability of the ventricle to relax, HFpEF, caused by left ventricular hypertrophy or an MI.
no symptoms or limitations on physical activity
What is NYHA-FC 2 classification?
What is NYHA-FC 3 classification?
What is NYHA-FC 4 classification?
Slight limitation of PA, Comfortable at rest but other activities cause HF symptoms.
Marked limitation of PA–> less than ordinary activity causes HF symptoms. One year survival here is 50%
Symptoms at rest
What is ACCA/AHA Stage A?
What is ACCA/AHA Stage B?
What is ACCA/AHA Stage C?
What is ACCA/AHA Stage D?
Patients with risk factors WITHOUT structural disease or damage.
Structural heart disease but no HF symptoms
Structural HD PLUS current/previous HF symptoms
Refractory HF requiring specialized interventions
How to treat Stage A?
How to treat Stage B- FC 1?
How to treat Stage C- FC 1-4, HFrEF?
ACEi or ARB, Statin, Aspirin, Glucose lowering agent
Same as Stage A including beta blockers
ARNi, or ACEi or ARB, Select beta blockers, Aldosterone Antagonists, Loop diuretics. Good also use hydralazine/ isosorbide dinitrate, digitalis, ibravadine
What are alternative therapies for Stage C- FC 1-4, HFrEF?
What is stage C pharmacotherapy for HFpEF?
How to treat Stage D HFrEF/HFpEF?
CRT,ICD, Revascularization, Valvular surgery.
Loop diuretics used for NY class 2-4. Manage comorbidities, Control SBP <130.
Establish end life goals, Mechanical circulatory support, heart transplant, clinical trials, palliative care and hospis.
How does an ARNi work?
What is the ARNi target dose?
What are the ARNi ADR’s? What did the PARADIGM trial show?
Sacubitril–> Neprilysin inhibitor, lowers vasodilatory peptide degradation.
increase to target dose until no longer able to. Sacubitirl 97mg/ Valsartan 103 mg.
Renal function impairment, Hypotension, Hyperkalemia, Angioedema. Enestro superior to enalapril in 20% of patients and halted early
Should you replace a patients ACEi or ARB in heart failure with an ARNI?
What are the ACEi to use in heart failure?
What are the ARB’s used in hf?
YES, do not co administer within 36 hours of an ACEi, do not administer in patients with history of angioedema. Benefits include low mortality, hospital rates, and improvement of HF signs and symptoms
Enalapril(20 mg BID), Lisinopril(40 mg daily)
Losartan(150 mg qday), Valsartan(160 mg BID)
What are the beta blockers with proven HF benefit?
How to dose the beta blockers? Place in therapy?
What is spironolactones target dose? What is it’s place in therapy?
Bisoprolol, Carvedilol, Carvedilol XR, Metoprolol Succinate
Titrate slowly over 8-12 weeks. 1st line therapy in HFrEF
25 mg daily. HFrEC(<35%) 2-4 unless CI’d.
What is the mainstay of HF treatment?
What are the benefits of digitalis?
What to know about Hydralazine/ISDN in HF?
Loop diuretics, NO MORTALITY BENEFIT, thiazides not potent enough
improved exercise tolerance and quality of life. NO MORTALITY BENEFIT. Place in therapy is patients ON target doses of GDMT(acei, bb, aldosterone, loop) but who still have persistent symptoms. Once on it they tend to do worse if stopped.
Used in AFRICAN AMERICANS NYHA Class 3-4 on target dose of acei and BB
What to know about ivabradine in HF?
What medications are potentially harmful?
What are the target doses for the beta blockers?
Dose is based off of HR, ADR is bradycardia and atrial fibrillation. Reason for use is recurrent HF hospitlization in those with target GDMI.
TZD’s, Digoxin, Doxorubicin
Bisoprolol- 10 mg daily, Carvedilol- 50 mg BID, Carvedilol XR- 80 mg Daily, Metoprolol Succinate 200 mg daily
