Heart Failure Flashcards
HRrEF impairment in cardiac function
systolic dysfunction: decreased contractility
HFpEF impairment in cardiac function
diastolic dysfunction: impairment in ventricular relaxation/filling
HFrEF definition
HF symptoms with EF < 40%
(could be asymptomatic reduced EF)
HFpEF definition
HF symptoms with EF > 50%
70% of HFrEF cases are caused by ____________ ___________ _______________
ischemic dilated cardiomyopathy
3 determinants of left ventricular function:
- Preload (venous return, LVEDV)
- Myocardial contractility (force generated at any given LVEDV)
- Afterload (aortic impedance and wall stress)
Drug-induced heart failure: negative ionotropics
- Antiarrhythmics (disopyramide, flecainide)
- B-blockers
- CCBs (non-DHP)
- Itraconazole
Drug-induced heart failure: direct cardiac toxins
Doxorubicin, Bevacizumab, blue cohosh, imatinib, ethanol, cocaine, amphetamines
Drug-induced heart failure: sodium/water retention
Glucocorticoids, androgens, estrogens, NSAIDs, COX2 inhibitors, rosiglitazone and pioglitazonee, Na+ containing drugs (i.e. carbenicillin DiNa+)
Clinical presentation of HF examples
SOB
swelling of feet/legs
difficulty sleeping due to breathing problems swollen abdomen with loss of appetite
cough with frothy sputum
increased urination at night
Right ventricular failure: S/Sx
(systemic venous congestion)
Sx: abdominal pain, nausea, bloating, constipation, anorexia
Signs: peripheral edema, JVD, HJR, hepatomegaly, ascites
Left ventricular failure: S/Sx
(pulmonary congestion)
Sx: dyspnea on exertion, orthopnea, bendopnea, PND, tachypnea, cough
Signs: rales, pulmonary edema, pleural effusion
Other major non-specific HF findings
- Fatigue/weakness
- Exercise tolerance
- Nocturia
- Cardiomegaly
BNP > ______ pg/mL may be indicative of heart failure
> 35
NT-proBNP > ______ pg/mL may be indicative of heart failure
> 125
HF NYHA classes
I: cardiac disease w/o resulting limitations of physical activity
II: cardiac disease resulting in slight limitations of physical activity
III: cardiac disease resulting in limitations of physical activity
IV: cardiac disease resulting in inability to carry on any physical activity w/o discomfort
HF AHA Stage A
High risk of developing HF (HTN, CAD, DM)
HF AHA Stage B
structural heart disease that is strongly associated with HF but NO s/sx of HF
HF AHA Stage C
current or prior symptoms of HF associated with underlying heart disease
HF AHA Stage D
advanced structural heart disease and marked symptoms of HF at rest despite maximal medical therapy and require specialized interventions
NYHA FC I is equal to which AHA stage?
Stage B
AHA stage C is equal to which NYHA classes?
NYHA II + III
NYHA FC IV is equal to which AHA stage?
Stage D
Asymptomatic rEF is what stage and what class?
Stage B
NYHA FC I
What drugs reduce intravascular volume?
diuretics, SGLT2i
What drugs increase myocardial contractility?
positive inotropes
What drugs decrease ventricular afterload?
ACEi
vasodilators
SGLT2i
What are the 5 GDMT drug classes?
- ARNI/ACEi/ARB
- Beta-blocker (metoprolol succ, carvedilol, bisoprolol)
- aldosterone antagonist
- SGLT2i
- Loop diuretic
Mechanism of action of aldosterone antagonists IN HF
block aldosterone’s effects and reduce cardiac remodeling
(NOT used for diuretic effect in HF)
What are the 3 beta-blockers used for HFrEF?
Carvedilol
Bisoprolol
Metoprolol succinate
Diuretics do not decrease _________, but instead decrease hospitalizations
mortality
Patients w/o symptoms of ________ ___________ should not receive diuretics
volume overload
What is an additional benefit of loop diuretics for HFrEF patients?
enhances renal release of prostaglandins, which increases renal blood flow and enhances venous capacitance
Furosemide 80mg PO = ______ mg IV
40
Furosemide 40mg IV = bumetanide ______mg IV
1mg
Bumetanide 1mg IV = Torsemide ______ mg IV
20
Thiazide diuretics may be used in what patients?
Mild HF patients
Pts with small amounts of fluid retention
Furosemide usual dose range
20-160mg QD or BID
Bumetanide usual dose range
1-2mg QD or BID
Torsemide usual dose range
10-80mg QD
HCTZ initial + maximum dose in HF
initial: 25mg/day
max: 100mg/day
Metolazone initial + maximum dose in HF
initial: 2.5mg/day
max: 10mg/day
Thiazides can cause ______calcemia while loops may cause ______calcemia
Thz = hyper
Loop = hypo
Hypotension and increase SCr or BUN/Cr ratio may be indicative of what?
Volume depletion
(BUN/Cr > 20:1 indicates dehydration and prerenal azotemia)
BUN/Cr normal ratio
15:1
While taking a thiazide, replace K+ if below _____mEq/L and replace Mg2+ if below _____mEq/L
K+ < 4mEq/L
Mg2+ < 2mEq/L
Why is treating hypokalemia and hypomagnesemia important in HF patients?
Because they can cause pump failure and arrhythmias if left untreated
What is one of the most important benefits of ACE inhibitors for HF patients?
inhibition of cardiac hypertrophy/reduction in remodeling
