HF Flashcards
Factors leading to HF
Muscular dysfunction, Mechanical disorder, combo
Risk factors of HF
HTN, Obesity, prediabetes/DM, ASCVD
NYHA classes
I: no limitation of physical activity
II: comfortable at rest, but ordinarily activity results in symptoms
III: comfortable at rest, but less than ordinary activity results in symptoms
IV: unable to carry on any physical activity with symptoms
Inotropic agents have not shown _____
improved survival survival in patients with HF
Cardiac glycosides MOA
Inhibition of NA/K atpase so less Ca is removed from the cell resulting in increased intracellular Ca/ increased contractile force
oral availability of cardiac glycosides
60-75%, half life 36-40H
cardiac glycoside elimination
renal excretion 60%, hepatic metabolism 40%
cardiac glycoside effects
decrease in compensatory sympathetic and renal responses
- increase contractility
- decreased end-systolic/ diastolic size
- increased CO
- increased renal perfusion
cardiac glycoside monitoring
Serum digoxin levels
HF symptoms
renal funciton
electrolytes (hypercalcemia, hypokalemia, hypomagnesemia)
digoxin toxicity signs and symptoms
cardiac: arrhythmias
noncardiac: anorexia, nausea, vomiting, abd pain, fatigue, weakness, dizziness, headache, neuralgia, confusion, delirium, psychosis
visual disturbances (halos, photophobia, color perception issues)
digoxin toxicity serum level
> 2 ng/ml
digoxin toxicity treatment
- stop digoxin
- oral/parenteral K supps
- lidocaine for ventricular arrhythmias
- propranolol for supraventricular arrhythmias
- atropine for AV block and bradycardia
- digoxin antibody if life threatening
digoxin toxicity ECG
- Decreased QT interval (shortened ventricular action potential)
- Increased PR interval (decreased AV conduction velocity)
ST segment depression
Sympathomimetic Amines aka
Adrenergic Agonists (dopamine and dobutamine)
Sympathomimetic Amines useful for:
Acute failure (diminished systolic function)
sympathomimetic amines not appropriate for
Chronic failure (tolerance, lock of oral efficacy, arrhythmogenic effects)
dobutamine vs dopamine
dobutamine preferred when there is need to improve low CO (no effect on alpha2-adrenergic receptors)
Phosphodiesterase inhibitor name
Milrinone
Phosphodiesterase Inhibitor MOA
Increase cAMP by inhibiting breakdown by phosphodiesterase = increase intracellular calcium = vasodilation
Drug reserved for severe decompensated heart failure
Milrinone
Drug shown to reduce risk of death and the combined risk of death or hospitalization in patients with HFrEF
Beta blockers
Shown to be effective in reducing risk of death in pts with HFrEF:
Bisoprolol, metoprolol (succinate), carvedilol
BB should be used in stable patients with:
no inotropic support
(negative intropic effect = symptomatic worsening/ acute decompensation)
BB monitoring
bradycardia, hypotension, fatigue, fluid retention/ worsening symptoms
Which drug class for the following?
- Prevent death
- Improved survival by 20-30%
- slows progression
- Reduced hospitalization with current or prior symptoms
ACE/ARB
ACE/ARB monitoring
- Hypotension
- Hyperkalemia
- Dry cough
- Angioedema
- Pregnancy
_____ is recommended to reduce morbidity and mortality
ARNi (Valsartan + Sacubitril)
ARNi MOA
Inhibiting neprilysin reduces breakdown of beneficial peptides (i.e. natriuretic peptides)
ARNi should not be co-administered with______
ACEi or within 36 hours of ACE because of risk of angioedema
Mediates major effects of RAAS (myocardial remodeling and fibrosis, sodium retention and K loss at distal tubules
Aldosterone Antagonist (K sparing diuretics)
Most effective for moderate to severe heart failure with dyspnea, and fluid overload
Diuretic therapy
_____ are preferred over thiazide & have a rapid onset and relatively short duration of action
Loop diuretics
For patients with HF and congestive symptoms, addition of _______ to a loop should be reserved for patients who do not respond to moderate-or high-dose loop diuretics to minimize electrolyte abnormalities
thiazide diuretic
Diuretic Therapy Monitoring
Considerations
- Volume depletion
- Prerenal azotemia
- Hypotension
- Hypokalemia (particularly with accompanying digoxin therapy)
- less common: skin rashes, GI distress, ototoxicity (loop)
Substantially reduce risk of CV death and hospitalization for HF for pts with reduced LVEF, with or without diabetes
SGLT2 inhibitors
_________ and _______ reduce cardiovascular death and heart failure hospitalization, and they have been approved for treating heart failure with reduced LVEF irrespective of the presence of type 2 diabetes
Dapagliflozin / empagliflozin
SGLT2 inhibitors also reduce ______
kidney disease progression
SGLT2 inhibitor monitoring
- genetic mycotic infections
- UTI
- polyuria
- risk of hypotension and hypovolemia due to osmotic diuresis
- euglycemic ketoacidosis
For patients self-identified as African American with NYHA class III/IV HFrEF who are receiving optimal medical therapy, the combination of _____ and ______ is recommended to improve symptoms and reduce morbidity and mortality
hydralazine/ isosorbide dinitrate
Nitrites
Intravenous vasodilators: sodium nitroprusside or nitroglycerin
Nitrite use
Acute/ Severely decompensate chronic heart failure, especially with HTN or MI
________ have no sustained effect in pts with heart failure and should not be used for this indication
Transdermal nitroglycerin patches
