Drugs for Heart Failure Flashcards
Principal symptoms of HF
Dyspnea and fatigue
Exercise intolerance
Fluid retention
Some present primarily with exercise intolerance, others fluid overload
People w/ HTN have a ___ increased risk of HF
6x
need to manage HTN
Several complex compensatory mechanisms to maintain cardiac output and oxygenation of vital organs
(4)
Increased sympathetic tone
Activation of renin-angiotensin-aldosterone system: Sodium and water retention
Cardiac remodeling (ventricular dilation and hypertrophy) (we don't have meds that affect this)
Other neurohormonal adaptations – endothelial hormones, vasopressin, natriuretic peptide
Sympathetic Autonomic Nervous System as it pertains to HF
Initially NE causes increased inotropic and chronotropic effects –> maintain near-normal CO and preserve perfusion of vital organs (CNS, heart)
Vasoconstriction in skin, GI, renal circulation decreases perfusion to these organs, and increases cardiac work load via –> SVR
in response to NE
beta1 receptors-G protein effector system ____ and with
beta 2 _______
beta1 receptors-G protein effector system downregulation
beta 2 not affected
this is why we give BB even though we see a further decrease in HR initially
but if we block the beta receptor you can re-sensitize the body to the NE that is there
w/ first dose sxs can worsen
ANP is the bodies
natural diuretic
Released from specialized cells in atrial (ANP) or ventricular (BNP) muscle in response to stretching of myocytes
Results in direct arterial vasodilation, increased GFR, and diuresis
Low output failure
diminished volume of blood pumped by a weakened heart in patients who have otherwise normal metabolic needs
High output failure
high metabolic demands due to underlying medical conditions (hyperthyroidism, anemia) –>healthy heart, pumps normal to high volume of blood; –> heart becomes exhausted fromincrease work load and unable to meet demand
High output failure tx
need to tx underlying condition
Ejection fraction (EF) < 40% Reduced myocardial muscle contractility Enlarged heart (dilated left ventricle)
HFrEF – systolic heart failure
Normal EF (>50%), decrease SV & CO
Normal left ventricular contractility
Stiff left ventricle with impaired left ventricular filling
HFpEF – diastolic heart failure
Heart Failure Etiology
Hypertension Valvular disease
Amyloidosis, sarcoidosis Coronary ischemia
Pericarditis
Drug Induced
Alcoholism Scarring post-MI
Enlarged left ventricular septum (hypertrophic cardiomyopathy)
Symptoms of heart failure
SOB Cough Orthopnea PND (paroxysmal nocturnal dyspnea) DOE (dyspnea on exertion) Reduced exercise tolerance Fatigue Weight gain Edema
Physical findings in HF
Tachycardia
Increasing weight
JVD or hepatojugular reflex
Presence of S3
Laterally displaced apical impulse
Fluid retention
Pulmonary crackles or
wheezes
Peripheral edema
Hepatomegaly
Objective test to measure EF (2-D echocardiogram with Doppler flow studies or cardiac catheterization)Non-pharmacologic Interventions To reduce risk of new cardiac injury
Attain or maintain normal weight
Smoking cessation
Alcohol consumption discouraged
Manage co-morbities (HTN, DM, HLP)
Interventions To reduce risk of new cardiac injury Maintain fluid balance
Na restriction, daily weight, fluid restriction
what is structural heart dz (stage B)
vascular dz
remodeling
valve issues
stage A of heart failure
pts without strucutral heart diease but with
htn dm atherosclerotic dz obesity metabolic syndrome
or using cardiotoxins or with Fhx
1st line TX for HF
ACEI and BB
staging A B C D of HF
doesn’t move back and forth
A. no structural abnormalities but high risk
B structural disease but without sxs
C. structural disease with prior sxs
D, refractory HF
RAAS drugs
ACE and ARB
BB
not CCB
Diuretics provide what kind of control in HF
sx
two kinds of K sparing diuretics
aldosterone antagonists: spironalactonin and eplerenone
inhibitions of Na/k pump: triamterene and amiloride
two types of aldosterone antagonists
spironlactone and
eplerenone has less hormonal effects and is more specific for receptors in the kidney and less overall steroid effect
which diuretics are used in HF
loop
how often do you dose loop diuretics in HF
once a day
2x daily for HTN
what labs do you want to monitor on a loop
K
creatinin to monitor their renal function
why do we worry about kidney function in loop diuretics?
decreased renal profusion through hypotension and decreased renal sufficiency
don’t want too dramatic of a diuresis
takes a while for interstitial fluid to redistribute back into the blood stream
Hypokalemic metabolic acidosis
name the loop diuretics (4)
which one can be used with a sulfa allergy
Furosemide Bumetanide Torsemide Ethacrynic acid " --->Only one that can be used w/ sulfa allergy
