Heart Failure Flashcards
Objectives: 3, 18, 19, 41, 42, 43
What is cardiac failure?
the heart is incapable of maintaining a CO adequate to accommodate metabolic requirements of the body.
What is a important cause of CF in the US?
systemic hypertension
What is the most frequent cause of diastolic cardiac dysfunction?
LVH, usually caused by HTN
How can we prevent CF in patients at stage A (HTN, CAD, structural abnormalities of myocardium) risk?
aggressive treatment of HTN, modifying coronary risk factors, reduce alcohol intake
How can we prevent CF in patients with stage B (hx of MI, reduced systolic function, LVH, valvular dysfunction?
ACE and B-blocker for 1st 2
early surgery for the other 2
What are the major symptoms of left sided failure?
SOB, chronic non-productive cough, nocturia, fatigue, exercise intolerance
What are the major symptoms of right sided failure?
fluid retention, dependent edema of LE, loss of appetite, nausea
What are common physical exam findings of a patient with CF?
Tachycardia, hypotension, reduced pulse, expiratory wheezes, rhonchi, or lung base crackles, thyroid abnormalities
What would be significant lab findings of CF?
high levels of troponin, anemia with high RDW, hypokalemia, hyponatremia, TSH hyper or hypo
What imaging techniques will help diagnosis? what will you see?
EKG - arrhythmia, MI, LVH
CXR - cardiomegaly, pleural effusions
Echo - size and function of all 4 chambers
cardiac cath - presence and extent of CAD
What are the treatment goals for CF?
symptom relief, improving functional status, preventing death (ACE and b-block reduce mortality) and hospitalizations
What is the most effective means of providing symptomatic relief to patients with moderate to severe HF?
diuretic therapy (loop most commonly)
What should be the initial treatment in most symptomatic patients with HF and reduced LV EF?
combination of diuretic, ACE inhibitor with b-blocker
what other condition can be managed with a beta-blocker in a patient with HF?
hypertension!
What are the names of 2 drugs classified as beta-blockers and used for HF tx?
Carvedilol and metoprolol
Which drug type should be avoided in the treatment of HF?
calcium-channel blockers, because can increase contraction. But they can be used to treat other things in HF patients (amlodipine, felodipine)
How do vasodilators help treat a patient with HF?
decrease cardiac preload and after load
What are 2 commonly used vasodilators in HF?
Nitrates and hydrazaline. These with an ACE or b-blocker, are highly effective in African Americanwith CHF
What drug should be added for patients who remain symptomatic when taking diuretics and ACEI, as well as for patients with heart failure who are in Afib and require rate control?
Digoxin
In which patients is digoxin contraindicated?
patients with diastolic or right-sided heart failure
How does digoxin work? and what are it’s side effects?
It’s a positive inotropic agent (increase CO) by influencing sodium and calcium ion flow and more Ca stays in the cell increasing contractility. Because of this a common SE is arrhythmia. Others include: CNS (HA, confusion, blurred vision)
Beside digoxin, what other inotropic agents are used to treat CF?
Dopamine, Dobutamine, Epinephrine
What is an indication for dopamine?
is the drug of choice for cardiogenic and septic shock
What is the drug of choice for acute heart failure in a hospital setting?
Dobutamine
What is a side effect of Dobutamine?
Afib, because it increases AV conduction
What is an indication for epinephrine?
anaphylactic shock, cardiac arrest
What drugs does epinephrine interact with?
cocaine, b-blockers, inhalation anesthetics
What is the major indication for Digoxin?
Heart failure with Afib
A patient who has documented heart failure is unable to engage in physical activity without discomfort. What NYHA functional classification are they?
Class IV
If a patient has no limitation in physical activity and ordinary activity does not cause symptoms, what NYHA class are they?
Class I
If a patient has symptoms on activity, but are comfortable at rest, what NYHA classification are they?
Class III
When is a beta-blocker contraindicated?
cardiogenic shock, symptomatic bradycardia, reactive airway disease, asthma
If a patient is on amiodorone can you also put them on digoxin if indicated?
no - adverse drug interactions!
