Heart Failure Flashcards
Indications for use of Digoxin in HF
1) Antiarrhythmic for patients with atrial fibrillation
2) Alleviates symptoms and decreases hospitalizations
Signs of Digoxin toxicity
Anorexia, N/V/D, fatigue, weakness, decreased HR, yellow/green halo vision, confusion, HA
Describe the effect that ACE inhibitors have on ventricular workload.
decrease preload and afterload.
Describe the benefits of using ACE inhibitors for heart failure.
reduces morbidity and mortality, reduces hospitilizations in HFrEF, slows disease progression: decreases or prevents ventricular remodeling.
When should ACE inhibitors be used in patients with HF?
recommended for all patients with a reduced ejection fraction to prevent HF, all patients with HFrEF unless contraindicated. (pregnancy, angioedema, K > 5.5)
How should ACE inhibitors be monitored?
BP, K+, renal function
Describe the effect that beta blockers have on ventricular workload.
decreases heart rate and is an antiarrhythmatic
Describe the benefits of using beta blockers for heart failure.
reduce morbidity and mortality, reduce hospitalizations, cause revers remodeling of left ventricle: returns heart to more normal size, shape, and function
How should beta blockers be monitored?
BP, HR, fluid status
Describe the effect that aldosterone antagonists have on ventricular workload.
decreases preload
Describe the benefits of using aldosterone antagonists for heart failure.
reduce morbidity and mortality, reduce hospitalizations
When should beta blockers be used in the management/treatment of HF?
recommended for all patients with a reduced ejection fraction to prevent HF, all stable patients with HF, unless contraindicated.
Start therapy at low doses, titrate slowly upward to the target dose and monitor closely as initiation tends to produce hypotension, fluid retention and bradycardia
When should aldosterone antagonists be used in the management/treatment of HF?
recommended for patients with NYHA class II-IV who have LVEF </= 40% with symptoms of HF or DM
How should aldosterone antagonists be monitored?
BP, K+, renal function (check baseline, in 3 days, 1 week, then every month for 3 months for spironolactone.
Describe the effect that diuretics have on ventricular workload.
decrease preload
Describe the benefits of using diuretics for treatment of heart failure.
relieve congestive symptoms (systemic edema)
When should diuretics be used in management/treatment of HF?
recommended in patients with HFrEF with fluid retention.
mild overload: thiazide (especially if pt has HTN)
moderate overload: loop (may need potassium supplement)
severe overload (pulmonary edema): intravenous furosemide.
avoid overdiuresis, espeically if starting an ACEI
How should diuretics be monitored?
BP, serum K+ (likely need K+ supplement unless on ACEI, ARB, or K+ sparing diuretic)
What are special considerations for beta blockers?
negative ionotropic effect; titrate slowly because of this.
When should angiotensin II receptor blockers be used for heart failure?
recommended for patients with HFrEF who are ACE inhibitor intolerant, alternatives to ACE inhibitors as first-line therapy in HFrEF, consider in persistently symptomatic patients with HFrEF on guideline directed medical therapy (in whom an aldosterone antagonist is not indicated or tolerated).
How should angiotensin II receptor blockers be monitored?
BP, K+, renal function
When should hydralazine/isosorbide be used for heart failure?
recommended for african americans with NYHA class III-IV HFrEF on guideline directed medical therapy or patients with HFrEF who cannot be given ACE inhibitors or ARBs.
How should hydralazine/isosorbide be monitored?
watch for headaches, palpitations, nsal congestion
When should digoxin be used for treatment of HF?
if no atrial arrhythmia, start BB so decrease HR from digoxin not preclude BB. No significant effect on survival of patients with HF, add digoxin for patients who remain symptomatic despite optimized treatment.
