Heart Failure- Congestive Heart Failure

Question 1

What are the four stages of heart failure?

Answer 1

Stage A: high risk for HF but no structural heart dz or symptoms
Stage B: structural heart dz but no signs or symptoms of HF
Stage C: structural heart dz with prior or current symptoms of HF
Stage D: Refractory HF requiring specialized interventions

Question 2

What is heart failure?
- hearts ability to function

Answer 2

When the heart fails to effectively pump blood throughout the body. This can happen bc of structural or functional irregularities in the heart o both.

Question 3

How many functional classifications are there? What are they? - quality of life

Answer 3

4.
Class 1: no limitation of physical activity
Class 2: Slight limitation of physical activity
Class 3: marked limitation of physical activity
Class 4: unable to perform any physical activity without symptoms or symptoms at rest

Question 4

What’s are the causes of congestive HF?

Answer 4

Usually involves dysfunction of the cardia muscle, of which the sarcomere is the basic unit. HF can occur with any of the disorders that damage or overwork the heart muscle: CAD, CARDIOMYOTPATHY, HYPETENSION. VALVULAR HEART DZ

Question 5

What can hypertension lead to if left untreated?

Answer 5

Cardiomegaly, bc the heart has to work against increased pressure.

Question 6

What can be found in the blood of someone who just had a heart attack?

Answer 6

Troponin

Question 7

What drug can be used in children for heart defects related to heart problems in children?

Answer 7

Digoxin. But it must be used carefully as the margin is very small.

Question 8

What should not be used n children for heart problems and why?

Answer 8

Phosphodiesterase inhibitors. This is because the research is unclear how effective it is compared to the adverse effects which are higher in children.

Question 9

Can HCN be used in children? If so when?

Answer 9

HCN agents can be used if HF is stable in children as small as 6 y/o

Question 10

What must we inform adults to do when taking Agents for treating HF?

Answer 10

Must instruct how to take own pulse and daily weights.
Any changes in Gi activity, medications or diet changes must be reported to provider - can have impact on electrolyte balance.
Avoid switching between brands of digoxin
Avoid pregnancy and lactation- only when benefit outweighs risk

Question 11

Digoxin

Answer 11

Cardioglycosides

Question 12

How do cardioglycosides work?

Answer 12

Increase force of myocardial contraction, cardiac output and renal perfusion and output and decreases blood volume to slow heart rate and conduction velocity through the AV node.
Overall effect is increased cardiac output.

Question 13

Glycosides are good at treating cardiac arrhythmias due to the action on the AV node and heart failure. T/f

Answer 13

True

Question 14

Cardiac glycoside contraindication

Answer 14

Allergy
Ventricular tachycardia or fibrillation, heart block, sick sinus syndrome.
Idiopathic hypertrophic subaortic stenosis
Acute MI, renal insufficiency and electrolyte abnormalities

Question 15

What number should the therapeutic dose of digoxin be at?

Answer 15

Levels should be 0.5-2 nano grams/ml anything above 1.2 is more likely to suffer from adverse effects. Anything over 2 can be toxic.

Question 16

What is the antidote for digoxin toxicity?

Answer 16

Digifab. - an antibody that binds to dixogon molecules making it inactive

Question 17

Drug drug interactions of digoxin

Answer 17

Numerous. ‘Some examples include diuretics that effect potassium levels
Thyroid meds and antacids make digoxin less effective

Question 18

True or false. You should monitor apical pulse before administering digoxin

Answer 18

TRUE

Question 19

True or false. You should monitor apical pulse before administering digoxin

Answer 19

TRUE

Question 20

How should you administer Digoxin?

Answer 20

IV slowly over at least 5 mins. Avoid IM administration. - can be very painful. You should also have life saving equipment available in case of toxicity

Question 21

What should you avoid giving oral digoxin with?

Answer 21

Food and antacids

Question 22

Milrinone

Answer 22

Phosphodiasterase inhibitors
Milrinone is a drug that acts as cardiotonic (inotropic) agent

Question 23

Milrinone is a short term or long term management of HF for pts who are receiving digoxin and diuretics.

Answer 23

SHORT TERM. It can be given in cases of acute decompensated heart failure to quickly get the heart to a functional level.can be given when the body has not responded to other heart failure treatments.

Question 24

How does Milrinone work on the body?

Answer 24

Blocks enzyme phosphodiesterase, leads to increased win myocardial cell cyclic adenosine monophosphate (CAMP) Which increases calcium levels in the cell causing stronger stimulation; directly relaxes vascular smooth muscle.
Reduce work load on heart

Question 25

What is an important contraindication of phosphodiesterase inhibitor?

Answer 25

Severe pulmonic dz, acute MI, fluid volume deficit and ventricular arrhythmias. - the increase contraction strength and vessel dilation effects can cause hypertension and decreased oxygen to the heart. The vasodilation combined with low fluid volume would tank a persons Bp. Ventricular arrhythmias can be exacerbated.

Question 26

What levels are we going to want to monitor in patients taking phosphodiesterase inhibitors?

Answer 26

Platelet levels.

Question 27

Ivabradine

Answer 27

Hyperpolarization activated cyclic nucleotide- gated channel blockers (HCN BLOCKERS)

Question 28

How do HCN blockers work on the body?

Answer 28

Blocking the HCNs slows the hearts pacemaker, the sinus node, in the repolarizing phase of the action potential. Which leads to reduced HR. -phase 3. No risk of affecting ventricular repolarization or causing systemic effects like with beta blockers bc it works on SA node. The slowing rate allows the ventricular to become more filled between contractions thus increasing cardiac output. Great for pts who are maxed out on beta blockers as in they can’t get a higher does or can’t take beta blockers at all. Also good for pts with Stable with symptomatic heart failure

Question 29

Why do we use HCN blockers?

Answer 29

Reduces the risk of hospitalization for worsening of HF

Question 30

What are some contraindications of HCN blockers?

Answer 30

Allergy
Active, decompensated HF; hypotension; sick sinus syndrome or AV block; resting HR under 60 beats/min; pts completely dependent on a pace maker and severe hepatic impairment. Decreasing hr would worsen these.

Question 31

What are drug drug interactions of HCN blockers?

Answer 31

CYP3A4 inhibitors or inducers
Negative chronic tropic drugs
Grapefruit juice

Question 32

What are some contraindications for HCN blockers?

Answer 32

Can lower HR too much and cause bradycardia, hypertension, atrial fibrillation, and luminous phenomena (sudden changes in brightness in parts of the visual field, colored bright lights, image decompensation, multiple images)

Question 33

What are the drugs for Angiotensin receptor neprilysin inhibitor(ARN)?

Answer 33

SACUBITRIL
VALSARTAN

Question 34

How do ARNI drugs work?

Answer 34

Blocks breakdown of natriuretic peptides
Inhibits effects of RASS
Leads to decreased cardiac world load, lower vascular volume, lower Bp improved HF symptoms.
Prolong loss of sodium- therefore water- decrease volume- decrease cardiac workload,.
Low left ventricular ejection fraction , can be used in children 1 year or older.

Question 35

What are ARNI contraindications?

Answer 35

ANGIOEDEMA- swelling of the skin and mucous membranes which can lead to swelling of the mouth throat lips and tongue-allergic reactions.
Using with ACE or ARBS can increase the likely hood of angioedema. Aliskiren- can cause renal impairment

Question 36

Use of Arni with lithium can increase lithium toxicity

Answer 36

True