Heart Failure – Part 3:Treatment Flashcards

1
Q

Specific HF Goals of Rx

A

Correction of the underlying cause of HF
Elimination of precipitating factors
Reduction of congestion
Improve blood flow

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2
Q

Reverses fluid retention (Na loss)
The most common HF therapy
Can be used chronically and acutely
Side effects: dehydration, hypokalemia, sulfa, tinnitis

A

Diuretics

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3
Q

Diuretics:Treatment of Volume Overload

A

inc Salt (+Water) Excretion
dec intravasc fluids
dec venous congestion
*dec dyspnea volume

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4
Q

…prils (lisinopril, enalapril, benazepril) are all?

A

ACE Inhibitors

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5
Q

ACE Inhibitors fx

A

Direct vasodilation

Decreased aldosterone activation

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6
Q

ACE Inhibitors side effects

A

Hypotension
Worsening renal function (afferent vasocontraction)
Hyperkalemia
Cough
Angioedema: <1%, can occur after months of use

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7
Q

…sartans (e.g. valsartan, candesartan, losartan)

A

ARBs

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8
Q

ARBs fx

A

Block the receptor of angiotensin II

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9
Q

ARBs do not produce kinin potentiation (________)

Otherwise side effects are similar to ACEI

A

no cough

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10
Q

Mineralocorticoid Receptor Antagonists (MRA) fx

A

Spironolactone and eplerenone

Effect: Block mineralocorticoid receptor

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11
Q

Mineralocorticoid Receptor Antagonists (MRA) side effects

A

Hyperkalemia (requires close monitoring)

Gynecomastia (spiro only)

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12
Q

…olols (metoprolol, carvedilol, bisoprolol)

A

Beta-Blockers

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13
Q

Beta-Blockers fx

A

Antagonize effect of sypathetic system (epinephrine/norepinephrine)

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14
Q

Beta-Blockers side effects

A

Negative inotrope: short-term loss for long-term gain
Fluid retention
Hypotension
Decreased cardiac output, even cardiogenic shock
Bronchoconstriction

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15
Q

Vasodilation

Salt / Water Excretion

A

ACE INHIBITORS / ANGIOTENSIN RECEPTOR BLOCKERS

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16
Q

Decreased Contractility

May worsen symptoms

A

BETA BLOCKERS

17
Q

Salt / Water Excretion

Potassium retention

A

ALDOSTERONE RECEPTOR BLOCKADE

18
Q

Abort sudden cardiac death from ventricular tachycardia / fibrillation
Patients with LVEF <=35% or prior

A

Electrical therapies - ICD

Implanted Cardioverter Defibrillators

19
Q

ICD Cause the LV lateral wall and septal wall to contract together, which produces a more efficient:

A

contraction / ↑ stroke volume

20
Q

IV diuresis
Nitrates (if BP allows)
CPAP/BiPAP

A

HFpEF
(LVEF > 40%)
Acute
(Unstable)

21
Q

Control risk factors
DM, HTN, obesity
Control volume status

A

HFpEF
(LVEF > 40%)
Chronic
(Stable)

22
Q

IV diuresis
Nitrates (if BP allows)
CPAP/BiPAP (if SOB)
Pressors (if ↓↓↓CO, shock)

A

HFrEF
(LVEF ≤ 40%)
Acute
(Unstable)

23
Q
BB
ACEI/ARB
Aldosterone antagonist
Hydralazine / ISDN
\+/- Digoxin
ICD/CRT
A

HFrEF
(LVEF ≤ 40%)
Chronic
(Stable)

24
Q

HFrEF
(LVEF ≤ 40%)
Acute
(Unstable)

A

IV diuresis
Nitrates (if BP allows)
CPAP/BiPAP (if SOB)
Pressors (if ↓↓↓CO, shock)

25
Q

HFrEF
(LVEF ≤ 40%)
Chronic
(Stable)

A
BB
ACEI/ARB
Aldosterone antagonist
Hydralazine / ISDN
\+/- Digoxin
ICD/CRT
26
Q

HFpEF
(LVEF > 40%)
Chronic
(Stable)

A

Control risk factors
DM, HTN, obesity
Control volume status