Heart Failure – Part 3:Treatment Flashcards
Specific HF Goals of Rx
Correction of the underlying cause of HF
Elimination of precipitating factors
Reduction of congestion
Improve blood flow
Reverses fluid retention (Na loss)
The most common HF therapy
Can be used chronically and acutely
Side effects: dehydration, hypokalemia, sulfa, tinnitis
Diuretics
Diuretics:Treatment of Volume Overload
inc Salt (+Water) Excretion
dec intravasc fluids
dec venous congestion
*dec dyspnea volume
…prils (lisinopril, enalapril, benazepril) are all?
ACE Inhibitors
ACE Inhibitors fx
Direct vasodilation
Decreased aldosterone activation
ACE Inhibitors side effects
Hypotension
Worsening renal function (afferent vasocontraction)
Hyperkalemia
Cough
Angioedema: <1%, can occur after months of use
…sartans (e.g. valsartan, candesartan, losartan)
ARBs
ARBs fx
Block the receptor of angiotensin II
ARBs do not produce kinin potentiation (________)
Otherwise side effects are similar to ACEI
no cough
Mineralocorticoid Receptor Antagonists (MRA) fx
Spironolactone and eplerenone
Effect: Block mineralocorticoid receptor
Mineralocorticoid Receptor Antagonists (MRA) side effects
Hyperkalemia (requires close monitoring)
Gynecomastia (spiro only)
…olols (metoprolol, carvedilol, bisoprolol)
Beta-Blockers
Beta-Blockers fx
Antagonize effect of sypathetic system (epinephrine/norepinephrine)
Beta-Blockers side effects
Negative inotrope: short-term loss for long-term gain
Fluid retention
Hypotension
Decreased cardiac output, even cardiogenic shock
Bronchoconstriction
Vasodilation
Salt / Water Excretion
ACE INHIBITORS / ANGIOTENSIN RECEPTOR BLOCKERS
Decreased Contractility
May worsen symptoms
BETA BLOCKERS
Salt / Water Excretion
Potassium retention
ALDOSTERONE RECEPTOR BLOCKADE
Abort sudden cardiac death from ventricular tachycardia / fibrillation
Patients with LVEF <=35% or prior
Electrical therapies - ICD
Implanted Cardioverter Defibrillators
ICD Cause the LV lateral wall and septal wall to contract together, which produces a more efficient:
contraction / ↑ stroke volume
IV diuresis
Nitrates (if BP allows)
CPAP/BiPAP
HFpEF
(LVEF > 40%)
Acute
(Unstable)
Control risk factors
DM, HTN, obesity
Control volume status
HFpEF
(LVEF > 40%)
Chronic
(Stable)
IV diuresis
Nitrates (if BP allows)
CPAP/BiPAP (if SOB)
Pressors (if ↓↓↓CO, shock)
HFrEF
(LVEF ≤ 40%)
Acute
(Unstable)
BB ACEI/ARB Aldosterone antagonist Hydralazine / ISDN \+/- Digoxin ICD/CRT
HFrEF
(LVEF ≤ 40%)
Chronic
(Stable)
HFrEF
(LVEF ≤ 40%)
Acute
(Unstable)
IV diuresis
Nitrates (if BP allows)
CPAP/BiPAP (if SOB)
Pressors (if ↓↓↓CO, shock)
HFrEF
(LVEF ≤ 40%)
Chronic
(Stable)
BB ACEI/ARB Aldosterone antagonist Hydralazine / ISDN \+/- Digoxin ICD/CRT
HFpEF
(LVEF > 40%)
Chronic
(Stable)
Control risk factors
DM, HTN, obesity
Control volume status