Laflamme- Chapter 3 (Heart Failure) Flashcards
What dose of Bumetanide is equivalent to 40mg Lasix?
Bumetanide 1mg daily
What is Spironolactone dosing if CrCl 30-49?
25mg daily
What are three contraindications to ACEi/ARB use?
- Angioedema
- RAS
- Pregnancy
What are contraindications for beta blockers?
- Active HF
- Shock
- Hypoperfusion
- Asthma
- PR > 240 msec
- 2nd or 3rd deg heart block
- Severe PAD
What are 2 contraindications for MRA use?
- Hyper K > 5.0
- GFR < 30
What part of the nephron does MRA work on?
-Collecting tubule
Name 5 mechanisms for Diuretic resistance
- Post sodium excretion stimulation of the RAAS
- Decreased absorption due to edema of the intestinal wall
- Decreased CO and getting diuretic to kidney
- Hypertrophy of distal tubule
- Cardiorenal syndrome
How does Digoxin work?
Inhibits the Na-K-ATPase pump which increased intramyocyte Ca (increases inotropy) and increases vagal tone
What is serum target level for digoxin?
-0.5-0.9 ng/ml
Name 12 medications that increase Digoxin levels
- Amiodarone
- Verapamil
- Nifedipine
- Carvedilol
- Captopril
- Propafenone
- Quinidine
- Spironolactone
- Cyclosporine
- Macrolides
What % of HF patients have Central Sleep Apnea?
40%
What is Cheyne-Stokes breathing?
- Hyperventilation followed by apnea (>10 seconds) with no ventilatory effort
- This is associated with pulmonary congestion and is an independent RF for mortality.
-What is the treatment for Cheyne Stokes breathing?
- Optimize HF therapy
- There is no benefit for CPAP (CANPAP) or Servo-Ventilation (SERVE HF, increased mortality)
What % of HF patients have OSA?
-10 %
What are the 6 echo features of diastolic dysfunction?
- E/e prime > 15
- E/A inversion during valsalva
- Diastolic dominance of PV inflow
- Prolonged reversal of flow in PV during atrial kick
- LA dilatation
- Pulmonary hypertension
What is the MOA of Nitroglycerin?
- NO intracellular -> cGMP in smooth muscle cells -> leads to Vasodilation
- Venous vasodilator > Arterial/Coronary
What is the MOA of Nitroprusside?
-Balanced vasodilator with a shorter have life than nitroglycerin
What is the unique risk of Nitroprusside?
-Cyanide toxicity
How does Nesiritide work?
- Recombinant BNP
- No benefit in ASCEND HF, ROSE AHF
What is the MOA of Dobutamine?
-Beta 1 and Beta 2 agonist
What is the MOA of Dopamine?
- Positive inotrope and vasopressor
- Vasodilator at low doses
- It is a NE precursor
What is the MOA of Milrinone?
-PDE3 Inhibitor -> increased intracellular CAMP -> Increased intracellular Ca2+
What are hemodynamic targets for the following during HF management for the following: LCWP, CVP, BP, SVO2, SVR, CI
- Wedge < 18
- CVP < 8
- MAP > 60
- SVO2 > 70%
- SVR 1000-1200
- CI 2.2
How much do the following increase CO? IABP, Impella, ECMO
- IABP: 10-15%
- Impella: 2.5-5L/min
- ECMO: 5 L/min
When to list for transplant on basis of CPX?
-14 (12 if on BB)