Heart Failure Therapies

Question 1

What are the general aproaches to Tx of HF?

Answer 1

Base Tx on Functional Class
Reverse Treatable problems 
-CAD => Reperfusion
-Repair Structural ABN
Agressive screening for DM
Immunize for Pneumonia, influenza
Appropriate Activity and Rest

Question 2

What are the worsening factors of HF?

Answer 2

*Dietary Indiscression
*Inappropriate Reduction in HF meds
Myocardial Ischemia
Arrhythmias

Question 3

What are the stages of HF?

Answer 3

A-No structural Heart Disease or Sx
B- Structural Disease but no Sx
C- Structural Ds with Sx (Largest Group)
D- Refractory HF

Question 4

What are the general measures for HF therapy?

Answer 4

HF risk factor reduction
Education: Smoking, EtOH, Na restriction, fluid intake, monitor for Weight gain
Activity: Heavy physical labor not recommended, Compensated HF (I-III) can exercise
Diet
Manage Fluid Status
-measure fluid intake
-Diuretic

Question 5

How can progression be prevented in HF?

Answer 5

Counteract neurohormonal activation 
-ventricular remodeling result of:
---Adr Activation
---Renin-angiotensin-aldosterone syst activation
Altering activation can:
\++relieve symptoms
\++stabilize or reverse remodeling

Question 6

What are the anti-neurohormonal drugs?

Answer 6

ACE-Inhibitors
ARB(angiotensin receptor blockers)
Beta Blockers

Question 7

What is the function of ACE I in HF?

Answer 7

What are the adverse effects of ANgiotensin II that are prevented by ACE-I?
Myocyte Hypertrophy
Apoptosis
Presynaptic Facilitation of NE release
Myocyte Toxicity
Proliferation of Fibroblasts (myocardial fibrosis)

Prolong life
Reduce and prevent hospitalizations
Improve symptoms

Question 8

What is the purpose of ARBs in HF?

Answer 8

Block effects of AT-II on receptors
Used when ACE-I not well tolerated (cough or rash)
Good in combo with ACE-I

Question 9

What is the Purpose of Beta Blockers in HF?

Answer 9

Decreases Adrenergic Activation on B-1 receptors:
Reverse process of LV remodeling 
Improve symptoms 
Prevents Hospitalization
Prolong life

B-1 selective (metoprolol) and vasodilating BB Carvedilol

Question 10

Waht is the Purpose of Spironolactone in HF?

Answer 10

Aldosterone antagonist

Question 11

How does an intra-aortic Baloon pump work?

Answer 11

Triggered by R waves.
Helps reduce afterload as a secondary Pump.
Used after acute episodes or surgery.