Heart Failure

Question 1

Sacubitril

Answer 1

Class: ARNi
+ Valsartan
Preferred over ACEi

MOA:

• Angiotensin receptor-neprilysin inhibitor
• Blocks neprilysin
• ARB for angiotensin II accumulation

Use(s):

• Patients w/HFrEF
  
  • LVEF < 40%

Adverse Effect(s):

• Hypotension
• Hyperkalemia
• Angioedema
• Teratogenic (Valsartan)
• Dec. renal function w/NSAID

Contraindication(s):

• Angioedema
• Patients taking ACEi
• Patients w/diabetes, Aliskiren

Question 2

Captopril
Enalapril
Lisinopril

Answer 2

MOA:

• Dec. afterload
• Dec. preload
• Dec. long-term heart remodeling

Use(s):

• Patients w/heart failure
• Patients w/dec. LVEF
• Patients w/past MI

Adverse Effect(s):

• Hypotension
• Persistent dry cough
• Hyperkalemia
• Angioedema
• Acute renal failure
• Teratogenic

Contraindication(s):

• Patients w/bilateral renal artery stenosis
• Patients w/angioedema
• Pregnancy

Question 3

Candesartan

Valsartan

Answer 3

Class: ARB

MOA:

• Potent competitive antagonist
  
  • Angiotensin type I receptor
• NO effect on bradykinin level

Use(s):
- Heart failure

Adverse Effect(s):

• Hypotension
• Hyperkalemia
• Angioedema
• Acute renal failure
• Teratogenic

Question 4

Bisoprolol
Carvediolol
Metoprolol

Answer 4

Class: B-blocker
Recommended in addition to ACEi

MOA:

• Dec. HR & contractility
• Inhibit renin release
• Dec. remodelig & hypertrophy
• Initial exacerbation of symptoms

Use(s):

• Symptomatic heart failure
• Asymptomatic patients w/dec. LVEF
• Asymptomatic patients w/past MI
• Decompensated HF (cautiously)

Adverse Effect(s):
- Fluid retention

Contraindication(s):

• Cardiogenic shock
• Asthmatics
• Severe bradycardia

Question 5

Diuretics

Answer 5

MOA:

• Dec. plasma volume
• Dec. preload
• Dec. CO & O2 demand
• Dec. afterload

Use(s):

• Pulmonary congestion
• Peripheral edema
• Dec. volume overload
• CHF

Question 6

Spironolactone

Answer 6

Class: Thiazide

MOA:

• Aldosterone antagonist
  
  • Prevent Na retention
  • Prevent myocardial hypertrophy
  • Prevent hypokalemia

Use(s):
- Advanced heart failure

Adverse Effect(s):

• Hyperkalemia
• GI disturbances
• CNS effects
• Endocrine abnormalities

Question 7

Hydralazine + Isosorbide dinitrate

Answer 7

MOA:

• Inc. vasodilation = dec. preload
• Inc. arterial dilation
  
  • Dec. systemic arterial resistance
  • Dec. afterload

Use(s):

• LVEF
• Patients not able to use ACEi or ARB
• AA patients w/advanced HF

Adverse Effect(s):

• Headache
• Dizziness
• Tachycardia
• Peripheral neuritis
• Lupus-like syndrome

Contraindication(s):
- Sildenafil

Question 8

Dapagliflozin

Answer 8

Class: SGLT2 Inhibitor

MOA:

• Osmotic diuresis & natriuresis
• Dec. arterial pressure & stiffness
• Dec. preload/afterload
• Favorable effects on myocardial remodeling

Use(s):

• Dec. HF hospitalizations
  
  • Patients w/diabetes

Adverse Effect(s):
- UTI

Question 9

Ivabradine

Answer 9

Class: If Channel Inhibitor

MOA:

• Inhibit cardiac pacemaker If current
• Dec. HR

Adverse Effect(s):

• Bradycardia
• Atrial fibrillation
• Sinus arrest
• QT prolongation
• Torsade de pointes

Contraindication(s):

• HFpEF/decompensated HF
• Arrythmia
• Heart block
• BP < 90/50 mmHg
• HR < 90/min
• Severe liver failure
• CYP3A4 inhibitors