Heart Failure

Question 1

Treatment of Heart Failure

Answer 1

1) Identify/ treat underlying condition
2) Diuretics for pulmonary congestion and vasodilators/ inotropes for CO
3) Modulate neurohormonal response to modify remodeling

Question 2

Treatment for Structural Heart Disease No Symptoms

Answer 2

ACE inhibitors or ARBs

Question 3

Treatment for Structural Disease with Symptoms

Answer 3

(In Order)

1: B-Blockers
2: Diuretics & digoxin
3: Aldosterone Antagonist & nesiritide

Question 4

Treatment for Refractory Symptoms

Answer 4

Inotropes

Question 5

Balanced Vasodilator Therapy

Answer 5

Isosorbide dinitrate (venous) + hydralazine (arteriolar)
OR
ACE inhibitor
-increases survival

Question 6

ACE inhibitors in HF

Answer 6

-Standard first line therapy
-balanced venous and arteriolar dilation
-extends survival
-Don’t reduce BP in HF because there is an increase in CO but decrease in Resistance so the effect is neutralized
(Note, this is different from ACE in a normal heart for hypertension)
-Cough side effect

Question 7

B-Blockers in HF

Answer 7

Bad:
-depress contractility
-slight increase in vascular resistance
Good:
-Reduction in HR
-blunt cardiotoxic sympathetics
-survival benefit

Question 8

Diuretics in HF

Answer 8

-Use only with pulm congestion and edema

Question 9

Loop Diuretics

Answer 9

• POWERFUL diuretics

- Side effects include hypokalemia and metabolic acidosis

Question 10

K+ sparing diuretics

Answer 10

• Weak diuresis

- Can be used in conjunction with Loop Diuretics to retain potassium

Question 11

Digoxin

Answer 11

• Increases contractility
• Comes from Foxglove
• Sodium potassium ATPase inhibitor, leads to increased intracellular calcium
• Improved quality of life but does not prolong it

Question 12

Digoxin Toxicity

Answer 12

• dosing difficiulty, narrow theraputic index
• problems in renal dysfunction
• LIFE THREATENING ARRHYTHMIAS

Question 13

Nesiritide

Answer 13

• vasodilation
• Na+/H2O excretion
• Should be good, but isn’t

Question 14

Aldosterone Negative Effects

Answer 14

• cardiac fibrosis
• adverse ventricular remodeling
• Block with Aldosterone Antagonist

Question 15

Spironolactone

Answer 15

-Aldosterone antagonist

Question 16

Eplerenone

Answer 16

-Aldosterone antagonist

Question 17

Inotropic Drugs

Answer 17

• for urgent life threatening symptomology

- B-Adrenergic agonist

Question 18

Dopamine

Answer 18

B-Adrenergic Agonist

Give when: HF + hypotension + poor renal perfusion

Question 19

Dobutamine

Answer 19

B-Adrenergic Agonist

Give when: HF with no hypotension

Question 20

Isoprotenerol

Answer 20

B-Adrenergic Agonist

Give when: HF with slow HR and high BP

Question 21

PDE-3 Inhibitors

Answer 21

• inhibit PDE3 isozyme
• increase contractility
• vasodilation
• NOT USED BECUASE OF ARRYTHMYAS

Question 22

Drugs for Increasing Life Expectancy in HF

Answer 22

ACE
ARB
B-Blocker
Hydralazine/ nitrates
Aldosterone inh

Question 23

Drugs for Decreasing Symptoms in HF

Answer 23

Diuretics
Vasodilators
Digoxin
Inotropes