Heart Failure Flashcards
What is the definition of heart failure?
Failure of the heart to pump blood to tissues
What positive feedback system occurs w/ heart failure?
Structural remodeling
What is the #1 cause of LT-HF? What are the two different types of this cause?
Ischemic heart disease
Coronary artery disease
Myocardial infarction
What is the #1 cause of RT-HF?
LT-HF
What can cause isolated chronic RT-HF? Acute RT-HF?
COPD
PE
What is another name for isolated Rt-HF? What does it mean?
Cor pulmonale
Lung disease that leads to RT-HF
What is the duty of the RT side of the heart?
Receive blood from systemic circulation
Pump blood to lungs
What is the duty of the LT side of the heart?
Receive oxygenated blood
Pump blood out to systemic circulation
What is another name for HF? (CHF)
Congestive Heart Failure
What are the Sx of LT-HF? What is it caused by?
- paroxysmal nocturnal dyspnea
- orthopnea
- tachycardia
- fatigue
- SOB/dyspnea
pulmonary edema
What are the Sx of RT-HF? What is it caused by?
- JVD
- ascites
- hepatomegaly/splenomegaly
- weight gain
- dependent edema “pitting edema”
Systemic edema
What are the 3 different types of HF? What do they each stand for?
HFpEF(HF w/ preserved EF)
HFrEF(HF w/ reduces EF)
HFmrEF(HF w/ mid range EF)
What is normal EF?
50-65%
What is the equation for figuring out EF%?
SV/ EDV= EF%
What is the EF for a pt w/ HFrEF?
<40%
What is the EF for a pt w/ HFpEF? How is this possible?
> 50%
SV is normal but EDV is low b/c of ventricular hypertrophy
What is the general protocol for Tx of HF? How do each of them help w/ Sx of the pt?
- diuretics-decrease edema
- vasodilators-decrease workload on heart and redistribute edema
- beta blockers-decrease tachycardia
When are cardiac glycosides used?
When other medications for HF don’t work
What are the 3 goals of drugs when Tx HF?
- improve Sx
- slow deterioration
- reduce mortality
What are the 3 homeostatic mechanisms to maintain fluid balance in the lungs?
Preload
LT ventricular contractility
Afterload
What is the goal of drug therapy in Acute HF?
Optimize volume status
What is euvolemic?
Dehydrated body fluid level
What is the goal of diuretics in HF? What does this decrease?
Decrease the excess fluid by peeing it out?
Decreases preload
What are the 3 types of diuretics used for CHF?
Thiazides
Loops
K+ sparing
Why is there delayed diuretics w/ furosemide(Lasix)? What is given to increase the diuretics?
B/c the diuretics are emptying the edema from the body instead of the lung edema
Give a vasodilator
What type of drugs are balance vasodilators?
ACEIs and ARBs
What effect is nitroglycerin going to have on pts preload and afterload? What route and dose is going to be best to cause these results?
Decrease preload and afterload
High dose IV nitroglycerin
What does PDE5 and nitroglycerin cause in the body when taken together?
Severe drop in BP
What is the general protocol for Tx of pts w/ acute HF?
Vasodilator first (fluid redistribution)
Diuretics next (fluid removal)
What is the goal of beta blockers for HF in the heart? In the kidneys?
Decrease BP
Decrease workload on heart
Decrease renin release
What does neprilysin breakdown?
ANP/BNP
Bradykinin
AT-2
What is digoxin(Lanoxin) used for? What are the 2 effects it causes on the heart?
HF
A-fib
Positive inotropic effect
Negative chonotropic effect
What does digoxin(Lanoxin) cause positive inotropic effect?
Because of the blocked Na/K pump which increases Ca2+ in the heart=increasing contractility force
Why does digoxin(Lanoxin) cause a negative chronotropic effect?
Because it stimulates the vagus nerve which has more parasympathetic nerves=decreasing HR
What is another name of digitalization?
Loading dose
How is digoxin(Lanoxin) given?
Digitalization then maintenance
What is the normal levels of digoxin(Lanoxin) in the body?
0.5-2.0 nanograms/ml
What electrolyte levels increases the effect of digoxin(Lanoxin)?
Hypokalemia
Hypercalcemia
What is the normal levels for K+?
3.5-5.0mEq/L
What type of drugs should a pt increase their K+ intake?
Diuretics
Digoxin
What are the ADR of cardiac glycosides?
N/V
Cardiac arrhythmia
Disturbances in color (blurred and yellow fields of vision)
What levels should you monitor when a pt is on digoxin(Lanoxin)?
Serum digoxin (0.5-2.0ng/ml) K+ levels(3.5-5.0mEq/L) Apical pulse(above 60HR)
Why is beta-blockers given at low doses to pts in HF?
Because the decrease in SV and HR can increase the rate of HF
Why is hyperkalemia a ADR of ARNi drugs?
Because of the ARB that blocks aldosterone increase to get rid of K+
Why is Hypotension a ADR of ARNi drugs?
Because of the neprilysin inhibitor that drains a lot of fluid out of the body
What do SGLT-2 inhibitors end in?
-gliflozin
What is the MOA of SGLT-2 inhibitors? SOA? Indications?
Inhibits reabsorption of Na and glucose
PCT
HFrEF and DM
Before giving any dose of drug for HF, what must be done?
Count apical pulse for 1 min
What are the contraindications for HF drugs?
<60HR >100HR anorexia N/V Diarrhea Visual disturbances -yellow and green halos
What physical findings show positive therapeutic effects to drug Tx for HF?
Increased urine output
Improved peripheral pulses, skin color and temperature
Decrease dyspnea, SOB and edema
