Heart Failure Flashcards
Treatment of Heart Failure
1) Identify/ treat underlying condition
2) Diuretics for pulmonary congestion and vasodilators/ inotropes for CO
3) Modulate neurohormonal response to modify remodeling
Treatment for Structural Heart Disease No Symptoms
ACE inhibitors or ARBs
Treatment for Structural Disease with Symptoms
(In Order)
1: B-Blockers
2: Diuretics & digoxin
3: Aldosterone Antagonist & nesiritide
Treatment for Refractory Symptoms
Inotropes
Balanced Vasodilator Therapy
Isosorbide dinitrate (venous) + hydralazine (arteriolar)
OR
ACE inhibitor
-increases survival
ACE inhibitors in HF
-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
B-Blockers in HF
Bad: -depress contractility -slight increase in vascular resistance Good: -Reduction in HR -blunt cardiotoxic sympathetics -survival benefit
Diuretics in HF
-Use only with pulm congestion and edema
Loop Diuretics
- POWERFUL diuretics
- Side effects include hypokalemia and metabolic acidosis
K+ sparing diuretics
- Weak diuresis
- Can be used in conjunction with Loop Diuretics to retain potassium
Digoxin
- Increases contractility
- Comes from Foxglove
- Sodium potassium ATPase inhibitor, leads to increased intracellular calcium
- Improved quality of life but does not prolong it
Digoxin Toxicity
- dosing difficiulty, narrow theraputic index
- problems in renal dysfunction
- LIFE THREATENING ARRHYTHMIAS
Nesiritide
- vasodilation
- Na+/H2O excretion
- Should be good, but isn’t
Aldosterone Negative Effects
- cardiac fibrosis
- adverse ventricular remodeling
- Block with Aldosterone Antagonist
Spironolactone
-Aldosterone antagonist
Eplerenone
-Aldosterone antagonist
Inotropic Drugs
- for urgent life threatening symptomology
- B-Adrenergic agonist
Dopamine
B-Adrenergic Agonist
Give when: HF + hypotension + poor renal perfusion
Dobutamine
B-Adrenergic Agonist
Give when: HF with no hypotension
Isoprotenerol
B-Adrenergic Agonist
Give when: HF with slow HR and high BP
PDE-3 Inhibitors
- inhibit PDE3 isozyme
- increase contractility
- vasodilation
- NOT USED BECUASE OF ARRYTHMYAS
Drugs for Increasing Life Expectancy in HF
ACE ARB B-Blocker Hydralazine/ nitrates Aldosterone inh
Drugs for Decreasing Symptoms in HF
Diuretics
Vasodilators
Digoxin
Inotropes
