HF treatment Flashcards
Gen measures for HF tx
-tx underlying cause
-remove precipitating causes
-exercise to inc HR 60-80% max of 20-60min 3-5 times/week
-Diet (Na < 2-3g)
-alcohol (abstain if HF is alc induced
-Fluid intake (restrict to <2L/day if hyponatremia (<130) or if diuretics not working
-weight
-smoking cessation
-immunization
-thyroid management
Drug therapy strategies
-reduce intravasc volume (diuretics, SGLT2i)
-inc contractility (digoxin if we must)
-dec ventricular afterload (ACE, ISDN/hydralazine, SGLT2)
-neurohormonal blockade (ACE/ARB/ARNI, BB, MRA, SGLT2i)
Stage A tx
-only ACE/ARB if atherosclerotic disease
Stage B tx
-if previous MI or asx rEF
-ACE/ARB
-BB
Stage C tx
-ARNi/ACE/ARB
-BB
-MRA
-SGLT2 inhibitors
-+/- loop diuretic
-other options:
-ISDN/hydralazine (if black w persistent sx or if ACE/ARB intolerant)
-Ivabradine
-Vericiguat
-Digoxin if persistently sx
When to use diuretics
-when sx of fluid retention
-reduce hospitalizations but not mortality
-reduce sx of overload, improve exercise tolerance
-do NOT give to pt w/o sx = dehydration risk which activates SNS bc low blood volumes
Benefits of diuretics
-reduce fluid retention
-dec edema, pulmonary congestion, and JVD
-reduces preload and cardiac filling pressure
-reduce daily sx and improve ability to exercise
Diuretic MOA
-inc Na and water excretion
-reduces sodium reabsorption in nephron
Loop diuretics MOA
-block Na and Cl absorption in ascending loop
-enhance release of prostaglandin (opposite of NSAID)
-pt w impaired renal function may require higher dosing
Loop diuretic drugs
-Furosemide (Lasix): 20-40mg qd or BID upto 20-160mg qd or BID
-Bumetanide (Bumex): 0.5-1mg qd or BID upto 1-2mg qd or BID
-Torsemide (Demadex): 10-20mg QD* upto 10-80mg QD
-Ethacrynic acid (edecrin) 25-50mg qd or BID (only if sulfa allergy)
PO loop equivalent doses
-F 40mg
-B 1mg
-T 20mg
-E 50mg
-F 40mg PO is 20mg IV
