Management of HF Flashcards
Digitalis Ionotropy/Chronotropy
Positive/negative (inhibits symp and increases parasymp)
Digoxin Outcomes
Doesn’t improve survival, but does improve symptoms and rehospitalizations
Great Use for Digoxin
Pts w/ CHF/impaired contractility and rapid Afib
Adverse Effect of Digoxin
Conduction system abnormalities leading to arrhythmias, so slow regular rhythm in afib pt on digoxin may be complete heart block
Digoxin EKG Sign
Scooped ST segment
4 Stages of HF
A - at high risk bc associated conditions (HTN, CAD, etc) but no overt abnormalities
B - overt abnormalities but no symptoms
C - Symptoms upon exertion
D - advanced disease w/ symptoms at rest requiring intervention
4 Core Principles of Management
Diuretics to achieve euvolemia
ACEis in all pts who can tolerate it w/ systolic dysfunction
BBs in pts w/ stable compensated (not acutely symptomatic) HF
Avoid drugs w/ adverse effects like NSAIDs and nondihydros (verapamil, diltiazem)
Treatment for 4 Stages
A: Treat lifestyle stuff aggressively (exercise, fat, HTN, drug use), ACEi in DM or maybe HTN
B: Same stuff but ACEi and BBs for all appropriate
C: All notable meds (diuretics, ACEi, BBs, digitalis), and add dietary salt restriction
D: All earlier measures but need intervention: mechanical devices, heart transplant, IV ionotropic infusions for palliation. They’re pretty much fucked real soon
Therapy Switch for Blacks not Responding to ACEis
Switch to hydralazine (peripheral arterodilation) and nitrates
General Mech of ACEi and BBs
Reduce afterload
Adverse Effect of Diuretics
Chance of hypokalemia/increases likelihood of digoxin toxicity
Aldosterone Antagonists
Decrease Na retention and symp activation, but can have hyperkalemia problem so avoid w/ another potassium-sparing diuretic
