Management of Heart Failure

Question 1

“causes of heartfailure”

Answer 1

• at least 50% of cases will be due to systolic dysfunction (iscemic CM > Dilated CM> others)
• revesrible causes always need to be considered (coronary artery disease, thyroid disease, arrhythmias)

Question 3

outline some non-pharmacologic management for heart failure

Answer 3

Question 4

Question 5

treatments that prolong survival with people in HFPEF

Answer 5

none

Question 6

Question 7

ACE inhibitors end in ___

Answer 7

pril. first line therapy. saves lives and impraves LV systolic function and improves symptoms.
- montior BP, potassium and creatinine

Question 8

moa of ACEi

Answer 8

blocks angiotensin I to converting to angiotensin II.

Question 9

side effects and contraindications of ACE inhibitors

Answer 9

Question 10

ARBS end in ____.

Answer 10

sartans

Question 11

T/F ARBS are a first line therapy for heart failure

Answer 11

false. ACE is are first line. ARB may be used for HF in patients intolerant to ACEi.

Question 12

MOA of ARBS

Answer 12

blocks the AT1 receptors of the kidney to prevent Na and H2O retention

Question 13

MOA of aldosterone antagonists and sideeffects

Answer 13

it blocks aldosteroen receptors, increasing salt and water excretion. acts as a potassium sparing diuretic. indicated in HF with reduced EF for mortality benefit.

side effects gynecomastia and hyperkalemia

Question 14

T/F You should give aldosterone antagonists to someone struggling with huge preloads and S3 sounds

Answer 14

True. aldosterone antagonists block aldosterone receptors, INCREASING SALT AND WATER EXCRETION

Question 15

T/f diuretics, nitrates and digoxin has been shown to improve mortality in HFREF

Answer 15

false. it improves symptoms but not mortality.
- these meds often help to decrease preload and reduce edema

Question 16

MOA of digoxin (2 ways)

Answer 16

inhibits the NA+ and K+ ATP pump

• increases intracellular Ca2+ which increases cardiac contractility, increase SV.

it DECREASES AV node condution to reduce HR and reduce arrhthmia or atrial fibrillation

Question 17

side effects of digoxin

Answer 17

narrow therapeutic window

• most monitor potassium, creatinine, dig levl

Question 18

overallnpillars of HFREF therapy

Answer 18

1. ARNI or ACEi or ARB (prescribe one at a timeO)
2. beta blocker
3. aldosterone antagonist
4. SGLT2i

Question 19

first line therapy for ACUTE decomensated HF

Answer 19

recall that acute decompensated HRF is that they have HF but come in hypoxic , degenerative.

1. identification of precipitants is key.
2. basic resuscitation measures.
3. nitrates and diuretics should be first line
4. morphine can be hlepful
   - beta blockers should not be initiated early in this phase