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CardioPulm II > Heart Failure handout > Flashcards

Heart Failure handout Flashcards

1
Q

Fill

A

Diastolic dysfunction

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2
Q

Eject

A

Systolic dysfunction

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3
Q

Definition of Heart Failure?

A

ACC/AHA defines heart failure as “a complex clinical syndrome that can result from any structural* or functional* cardiac disorder that impairs the ability of the ventricle to fill with or eject blood

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4
Q

Which side of the heart has the failure?

A

Left Sided:

Includes Diastolic

DysfunctionSystolic Dysfunction

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5
Q

Description of Systolic Dysfunction?

A

ECHO:

EF < 40%**

Decrease contractility

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6
Q

Causes of Systolic Dysfunction?

A

CAD

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7
Q

Description of Diastolic Dysfunction?

A

Restriction in filling

ECHO: EF preserved

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8
Q

Causes of Diastolic Dysfunction?

A

↑ ventricular stiffness

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9
Q

Goals of Heart failure therapy?

A

Block the compensatory neurohormonal activation caused by ↓ CO↑ CO, ↓ afterload, and ↓ preload

Slow progression of cardiac dysfunctionImprove quality of life, ↓ hospitalizations

Decrease mortality/prevent premature death

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10
Q

Enalapril:

Starting Dose

Target Dose

A

Starting Dose: 2.5 mg BID

Target Dose: 10 mg BID

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11
Q

Lisinopril:

Starting Dose

Target Dose

A

Starting Dose: 5 mg daily

Target Dose: 
 20 mg (40mg) daily
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12
Q

Special Dose Requirements?

A

START THE ACE-I, increase does irrespective of BP as long the patient can tolerate—NOT FOR BLOOD PRESSURE)

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13
Q

Ace-I monitoring:

A

Serum creatinine, K+ and
BP 2 weeks after initiation and dose increase

Cough

Angioedema

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14
Q

ACE-I: Contraindications

A

Hx of angioedema

Bilateral renal artery stenosis (RAS)

Pregnancy

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15
Q

ARB : Benifits

A

↓ mortality in patients not taking ACE-I.

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16
Q

Intolerant to ACE-Is: When to Use ARBs

A

Angioedema*

Cough

*The use of an ARB should not be D/C because of angioedema from the ACE. *

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17
Q

Intolerant to ACE-Is: When NOT to use ARB?

!!!NOT!!!

A

Renal insufficiency

Hyperkalemia

18
Q

ARB medication: No dosing

A

Losartan

Valsartan

Candesartan

19
Q

ARB: Contraindication

A

Hx of angioedema

RAS

Pregnancy

20
Q

ARB: Monitoring

A

Serum creatinine, K+, and BP 2 weeks after initiation and dose increase

Angioedema

21
Q

β – Adrenergic Blockers:

Benefits

A

↓ mortality**

Everyone gets Beta blocker—the BACKBONE OF DRUGS ** Essentials

22
Q

β – Adrenergic Blockers:

Drug:

Starting Dose

Target Dose

A

Metoprolol succinate
Starting Dose
12.5 mg – 25 mg daily

Target Dose:
200 mg daily

Carvedilol
Staring Dose
3.125 mg BID

Target Dose
25 mg BID (wt 85 kg)

Bisoprolol (not uses in US)

“only approved for systolic”

23
Q

β – Adrenergic Blockers:

Dosing

A

Must be clinically asymptomatic, stable, and dry - (no fluid)***

24
Q

β – Adrenergic Blockers:

Monitoring

A

Monitoring: (monitor HF symptoms)

HR and BP
-Caution with marked bradycardia (< 90 mm Hg)

25
Q

β – Adrenergic Blockers:

When can’t we use them if blood pressure is too low?

A

Systolic 90’s LEAVE IT ALONE!!!!

26
Q

β – Adrenergic Blockers:

When can’t we use them if Heart rate is too low?

A

Increase Beta blocker over Ace : Hear Rate (different) –to low heart rate less than 60.

You may increase the dose of beta blocker if less than 60’s)
If the HR is in the 50’s

27
Q

Sinful Recommendation for β – Adrenergic Blockers:

A

Don’t increase two drugs at the same time: ACE and Beta Blocker

28
Q

What to check before increasing Beta Blocker?

A

Before increin: Renal Function, K+, cough, and BP (blood pressure—how low is too low ( Systolic 90’s LEAVE IT ALONE!!!!)

Do not have to wait to get target does for ACE or beta blocker –for the next visit

29
Q

The Randomized Cardiac Insufficiency Study (CIBIS III)

A

To assess whether a β – blocker as initial therapy in chronic heart failure is useful

In the intent-to-treat population, non-inferiority was met with bisoprolol as initial therapy compared to enalapril

30
Q

Use of β – Blockers and Concomitant Disease States:

Asthma!!

A

-β-blockers are recommended

Contraindicated in patients with asthma with active bronchospasm

31
Q

Use of β – Blockers and Concomitant Disease States:

Diabetes

A

β-blockers are recommended

Use with caution in patients with recurrent hypoglycemia

Heart Failure trumps all diseasing:
DM – masks, hypoglycemia

Masks tachycadia– counsel

32
Q

Use of β – Blockers and Concomitant Disease States:

Chronic Obstructive Pulmonary Disease (COPD)

A

β-blockers are recommended

33
Q

Symptomatic Patients:

Loop Diuretics

When to use?

A

Should be given to all patients with current or prior HF and reduced LVEF who have evidence of fluid retention.

34
Q

Symptomatic Patients:

Loop Diuretics

Benefits?

A

↓ pulmonary congestion/JVD (fluid in lungs)

35
Q

Symptomatic Patients:

Loop Diuretics

Mortality

A

No effect on mortality*****WILL NOT SAVE YOU , only for symptoms

No effect on mortality*****WILL NOT SAVE YOU , only for symptoms

36
Q

Symptomatic Patients:
Loop Diuretics

MEDICATIONS

A

Furosemide
Bumetanide
Torsemide

Effective in compromised renal function
Get to know, the dose generally,

The NYAII symptomes does go back an forth.

Work when crcl is low or renal impairment.

<30Cr/min –Work

37
Q

Symptomatic Patients:
Loop Diuretics

Dosing

A

Determined based on clinical response

Titrate to achieve dry weight (ALWAYS BASED ON DRY WEIGHT)

  • 1 – 2 lbs of weight loss per day
  • In an acute exacerbation: goal is to be 1 liter negative

May consider thiazide for diuretic resistance

38
Q

Symptomatic Patients:
Loop Diuretics

Monitoring

A

Signs of volume depletion

-Hypotension, dizziness, ↓ urine output, ↑ BUN/SCr (20-back off the dose)

39
Q

Loop Diuretics: Dosing Considerations

Hospital dosing in acute HF:

A

Use 40 mg IV as a single bolus dose

If patient is taking furosemide: double the first hospital dose

If PO: double the patient’s home dose

If IV: IV to PO conversion is 1:2 (i.e.e 10 mg IV =?

If the fluid retensiotn is reoccuring, that when we consider diuretics.

40
Q

Thiazide Diuretics:

Medication

A

Chlorthalidone
Hydrochlorothiazide *
Metolazone +

  • ↓ effectiveness if CrCl < 30 mL/min

+ Can be used in compromised renal function

Thazides do not work in people who have compromised renal function,

CrCrl <30mL/min, the only one that works is METALAXONE
-more than 30 (any of them work)

-Thiazide first 30mins prior to the LOOP*

41
Q

Aldosterone Antagonists

When to use:

A 
Should be given to all symptomatic patients with NYHA class II-IV and who have LVEF < 35% taking ACE-I,
 β – blocker, and diuretics (ALL THREE)  than add Spirinolactone
42
Q

Aldosterone Antagonists

Benefits

A

↓ mortality

CardioPulm II (11 decks)

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