Heart Failure

Question 1

What are the major causes of HF?

Answer 1

Chronic hypertension

Myocardial infarction

Question 2

What are the common signs and symptoms of HF

Answer 2

Peripheral edema
hepatomegaly
cardiomegaly
reduced ejection fraction 
pulmonary edema

symptoms:
decreased exercise tolerance
shortness of breath
fatigue

Question 3

What are dobutamine’s place in therapy?

Answer 3

acute decompensated heart failure

Question 4

What is dobutamine’s MOA?

Answer 4

Beta-1 and Beta-2 activation
Increased force of contraction
increased heart rate

Question 5

Counseling points for thiazide diuretics

Answer 5

avoid taking before bed
Monitor for ADEs especially related to electrolyte abnormalities
caution in patients with sulfa allergy

Question 6

Counseling points for loop diuretics

Answer 6

avoid taking before bed
monitor urine output
watch for signs of dehydration
give IV slowly to avoid toxicity

Question 7

What is Miltrinone’s MOA

Answer 7

Phosphodiesterase-3 inhibitor
increased cyclic AMP –> increased myocardial contractility
Vasodilation

Question 8

What are Miltrinone’s adverse effects?

Answer 8

Arrythmias

Hypotension

Question 9

What Meds are given during Stage C HF

Answer 9

symptoms and structural heart damage

Devices
ACE-i/ARM/ARNI
Bet-blocker
Diuretics
Digoxin or Aldosterone Antagonist

Question 10

What Meds are given during Stage D HF

Answer 10

Refractory HF requiring specialized intervention

Devices
ACE-i/ARB/ARNI
Beta-blocker
Diuretics
Digoxin or Aldosterone Antagonist

Question 11

What Meds are given during Stage D HF

Answer 11

Refractory HF requiring specialized intervention

Devices
ACE-i/ARB/ARNI
Beta-blocker
Diuretics
Digoxin or Aldosterone Antagonist
Inotropes