Heart Failure Flashcards
What is diastolic HF also called of?
HF with preserved EF (HFpEF)
What is systolic HF also called of?
HF with reduced EF (HFrEF)
What are examples of loop diuretics?
Furosemide, Torasemide, Bumetanide, Etacrynic acid,
Which transporter does loop diuretics working on?
Na+-K+-2Cl− symporter
Common ADR of loop diuretics?
- hypoNa, hypoK, hypoMg
- dehydration,
- hyperuricemia, gout
- dizziness, postural hypotension, syncope
in HFrEF, what is the 1st line drug to start with
- Diuretics or ACEi (or ARB) separately or together
What’s the use of diuretics in treating HF?
- relieving sx of congestion
- improve response to ACEi/ARB
- reduce risk of decompensation with beta-blockage
T of F, ACE and ARB can be used together in treating HF?
F - this combo increases mortality
When do you start beta-blocker the HF patient?
- Once patient is STABLE on a loop diuretics and a ACEi/ARB
What’s good about beta-blocker?
- Long-term benefits on hemodynamics (not short term)
- ## decrease maladapative effort
Which two drug decrease maladapative effort of heart in HF?
- ACEi/ARB
- Beta-blocker
What’s good about metoprolol versus carvedilol
Metoprolol - less hypotension
When will you use aldosterone antagonist?
- NYHA II, III. IV with EF
What to pay attention when on aldosterone antagonist?
Renal function and K level
Which 1st line for black HF patients (NYHA class III or IV, with EF
- Hydralazine + Nitrates
Digoxin effect in HF management?
Rate Control
- Carefully monitor digoxin level, as low level is with improved mortality, but level > 1.2 kills
What presence of DM change management of HF?
No
Any use of statin in managing HF patients?
NO
If HF patients has angina or HTN, can they use CCB?
Yes, CCB is safe if there is another indication in the setting of HF (but not to HF itself)
- also safe in post-MI setting
Give two examples of CCB?
Amlodipine, Nifedipine Diltiazem, Verapamil
What are examples of Dihydropyridine CCB?
Amlodipine, Nifedipine
What’s the non-DHP CCB?
Diltiazem, Verapamil
What’s special of Dhp CCB?
- “di” = “dead”
- works on both myocardium and vascular
- Vasodilator - reduce SVR -hypotension and relief of angina - however can cause reflex tachycardia -> detrimental for patients with ischemic symptoms
What’s special of non-DHP ccb?
- “non” - is actually selective for myocardium only
- reduce myocardial oxygen demand and reverse coronary vasospasm -> treat angina
- minimal vasodilation effect, less or no reflex tachycardia
