Heart Failure Info Flashcards
Right heart failure
Fluid buildup in abdomen Ascites Fatigue Anorexia Enlarged liver and spleen Swelling hands and fingers Distended jugular veins
Left heart failure
Thin and weAk Fluid buildup in lungs Kikexic Increased PCWP Cough Fatigue Tachycardia Body not adequately perfused
Symptomatic definition of HF
Mismatch between right and left heart volume outputs
Cardio centric definition of HF
Hearts inadequate ability to fill with or eject blood
Systolic HF
Decreased contractility and EF
Use Batista procedure
Diastolic HF
Decreased ventricular filling and cardiac output
Options for CHF
Heart transplant, VAS, or death
Main HF causes
Ischemia Idiopathic Viral Immune mediated HTN
Ischemic HF
Most common (70%)
Viral HF
Viruses don’t primarily attack myocardium, errantly end up there
Can cause cardiomyopathy
May require valvular surgery
Forces contributing to worsening HF
SNS and PSNS
Renin angiotensin aldosterone system
Goals of HF therapy
Improve/alleviate symptoms
Slow downhill slide toward transplant/VaD/death
Improve survival
Increase QALYs
QALYs improving drugs
Positive inotropes Diuretics Renin/angiotensin blockers Primary vasodilators Beta blockers Aldosterone antagonists
Positive inotropes
Cardiac glycosides
Cathecholamines
Bypiridiney
Digitalis MOA
Blocks Na/K pump
Nickname for bipyridines
Phosphodiesterase inhibitors
Bipyridines action
Increase cAMP, increase Ca, increase contractility
Long term has high mortality!!! Only use on short term acute HF (pt struggling to come off bypass)
Effects of diuretics
No direct effect on heart
Decreased preload, afterload, and edema
Net affect is decreased workload so decreased O2 demand
Effects of ACE inhibitors
Decreased venous tone, decreased SVR, preload, afterload, and BP
Patients intolerant to ACE inhibitors and ARBs respond to…
Hydralazine (Apresoline) and Isosorbide (Isordil)
Effect of beta blockers
Block chronic SNS that leads to apoptosis and remodeling
Decreases O2 demand
Beta blockers with long term HF survivability
Metoprolol (Lopressor, Toprol XL)
Carvedilol (Coreg)
LCZ696
50/50 mix Losartan and Sacubitril
Nephrilysin inhibitor
Stages of CHF
A: high risk, no symptoms (treat obesity, diabetes, HTN, etc)
B: symptom with severe exercise (ACE, ARB, diuretic, beta blocker)
C: symptoms with marked exercise (add digoxin, aldosterone antagonist, Hydralazine, nitrate)
D: severe symptoms at rest (LVAD, transplant)
Best drug combination for CHF
Digoxin, diuretic, amd ACE inhibitor
Effects of morphine
Lowers respiratory rate
Decreases preload and afterload
Eases anxiety
