Heart Failure Flashcards
What is the most common cause of HF
CAD (ischemia)
What are the stages of HF
Stage A
Stage B
Stage C
Stage D
What is Heart failure
Inability of the heart to maintain enough cardiac output to meet the metabolic demands of the body
What is Stage A heart failure
Cardiac risk factors
What is stage B HF
Structural heart disease W/O HF
What is stage C HF
Structural heart disease with HF
What is stage D HF
End-stage heart failure
What is the pathophys of HF
CAD
Hypertension
Cardiomyopathy
valvular dysfunction
What patients fall into Stage B HF
Previous MI
LV remodeling (LVH & low EF)
Asymptomatic valvular disease
What is class 1 of stage B/C HF
Asymptomatic / mild symptoms with strenuous exercise
no limitations
What is class 2 of B/C HF
sxs with ordinary activity but no symptoms at rest
What is class 3 of B/C HF
marked sxs with ordinary activity but no symptoms at rest
What is class 4 of stage B/C HF
Symptoms at rest
What are the patient goals of therapy
improve mortality
slow disease progression
alleviate symptoms
What are the ways you can reduce the myocardial work
afterload reduction
preload reduction
What are the physiological goals of HF therapy
reduce myocardial work
improve output
reduce morphological changes
How does the body react to a decrease in cardiac output
Baroreceptor response
Increased sympathetic tone
What occurs when the body activates the RAAS system
Sodium / water retention occurs which causes an increase in peripheral vascular resistance
how does the RAAS system lead to worsened HF
Short term it will initially boost CO but long term causes LV remodeling
What drug classes are useful for HF
RAAS
B-blockers
Diuretics
vasodilators
inotropics
What is the benefit of ACEi in HF
Decrease both preload and after load by decreasing TPR and H2O/Na retention
slows progression of renal insufficiency
What are the indications for ACEi in HF
Symptomatic / asymptomatic HFrEF
What is the MOA of ARBs
Prevents binding at the AT1 receptor site
Does NOT effect bradykinin levels (less incidence of cough /angioedema)
Which patients are aldosterone antagonists recommended
Stage C and D HF
What drugs make up ARNi
Sacubitril and valsartan
What is the MOA of ARNis
Inhibits endopeptidase that degrades BNP,ANP
promotes diuresis and promotes vasodilation
Why are ARNis combined with ARBs
Neprilysin degrades A2 so the ARB will block those effects
Where are beta 1 receptors found
Heart and kidneys
Where are beta 2 receptors found
lungs and vascular smooth muscle
What is the MOA of beta blockers
blocks sympathetic activity
decrease after load
decrease heart rate
decrease renin release
Which beta blockers are approved for heart failure in the US
Carvedilol
metoprolol succinate
Bisoprolol
What type of HF can beta blockers NOT be used in
acute HF
What is the benefit of using beta blockers in HF
improved survival in CHF
cardioprotective
improved LV hemodynamic function
decreased cardiac O2 demand
What are the adverse effects of beta blockers
fatigue
dizziness
AV block
bronchoconstriction
sexual dysfunction
changes glucose metabolism
What are common symptoms of HF
SOB
LE swelling
fatigue
PND
loss of appetite
swollen or tender abdomen
cough w/ frothy sputum
polyuria at night
impaired memory
What are the benefits / indications of diuretics
relief in pulmonary congestion
relief of peripheral edema
Which diuretics are used in managing HF
loop diuretics
What is the MOA of hydralazine
decrease after load
What is the MOA of isosorbide dinitrate
decrease pre-load and after load by being converted to nitric oxide in the body leading the ventilation
When are vasodilators useful in HF
In patients with current or previous symptomatic HFrEF who cant tolerate ACEi & ARB
** mortality benefit in African Americans
What is the adverse reactions to vasodilators
H/A
Hypotension
Tachycardia
***Hydralazine.. malar rash and glomerulonephritis
What is the MOA of Digoxin
Inhibits Na-K-ATPase
-increase intracellular Ca2+
increase cardiac contractility
**parasympathomimetic effects
When is digoxin recommended in HF
In stage C and D with EF<25%
NO EFFECT ON MORTALITY
What are the benefits of digoxin
decrease HF symptoms
increase exercise tolerance
decrease hospitalization rate
use in atrial arrhythmia tx
If a patient has HF and Afib what is the best drug to give them
digoxin
What are the adverse reactions of digoxin
Narrow TI
food decreases reabsorption
crosses placenta
What are signs of digoxin toxicity
bradycardia (m/c)
AV block
tachyarrythmias/ ventricular automaticity
delirium
N/V
What type of HF is digoxin typically used in
decompensated heart failure
What groups of drugs are short term IV inotropic therapies
PDEi
B1 agonist
Which drugs are PDEi inotrope
milrinone
What is the MOA go milrinone
decrease breakdown of cAMP
-increase cAMP allows for increase Ca2+ in myocytes and vasodilation of vasc smooth muscle
What drug is a B1 adrenergic agonist
dobutamine
What is the MOA of dobutamine
Agonizes B1 to increase heart rate
When is dobutamine used
increase cardiac rate and output w/ few vascular side effects
**pressor in states of acute heart failure (inotropic post CT surgery)
What are the adverse effects of dobutamine
same as Epi
**use in caution with afib
When is ranolazine used
stable angina
arrhythmias
used when other drugs have failed
What is the MOA of ranolazine
inhibits late stage Na+ current and improves O2 supply and demand
what are the side effects of ranolazine
prolonged QT
many drug interactions
