Systolic vs Diastolic HF

Question 1

Difference between Systolic and Diastolic HF:

CO

Answer 1

Systolic: decreased

Diastolic: decreased

Question 2

Difference between Systolic and Diastolic HF:

Ejection Fraction

Answer 2

Systolic: decreased

Diastolic: normal

Question 3

Difference between Systolic and Diastolic HF:

Diuretics

Answer 3

Systolic: decrease symptoms; 1st-line Tx if EDEMA is present

Diastolic: Use w caution (avoid excessive reduction of filling pressures)

Question 4

Difference between Systolic and Diastolic HF:

ACE-Inhibitors

Answer 4

Systolic: decreases mortality in chronic HF

Diastolic: decreases LVH

Question 5

Difference between Systolic and Diastolic HF:

Angiotensin Receptor Blockers (ARB)

Answer 5

Systolic: decreases mortality in chronic HF

Diastolic: may be beneficial

Question 6

Difference between Systolic and Diastolic HF:

Aldosterone Inhibitors

Answer 6

Systolic: decreases mortality in chronic HF

Diastolic: currently in RC trials

Question 7

Difference between Systolic and Diastolic HF:

Beta-Blockers

Answer 7

Systolic: decreases mortality in chronic HF

Diastolic: decreases HR and BP

*these effects are limited to
Bisoprolol, Carvedilol, andMetaprolol
*not seen w/ bucindolol

Question 8

Difference between Systolic and Diastolic HF:

Ca++-channel Blockers

Answer 8

Systolic: small/no benefit

Diastolic: decreases HR and BP

Question 9

Difference between Systolic and Diastolic HF:

Digoxin

Answer 9

Systolic: may reduce symptoms

Diastolic: Little or no role

Question 10

Difference between Systolic and Diastolic HF:

Nitrates

Answer 10

Systolic: useful in ACUTE HF
*combine w HYDRALAZINE in AA

Diastolic: use w caution (avoid excessive reduction of filling pressures)

Question 11

Difference between Systolic and Diastolic HF:

Phosphodiesterase Inhibitors (PDE-I)

Answer 11

Systolic: useful in ACUTE HF

Diastolic: small study in chronic HF was positive

Question 12

Difference between Systolic and Diastolic HF:

Positive Inotropes

Answer 12

Systolic: decrease symptoms, hospitalizations

Diastolic: not recommended

Question 13

Amrinone (Inamrinone), milrinone

Answer 13

Phosphodiesterase Inhibitor

• • inotropic effect
• increase contractility by increaseing cAMP and Ca++ influx

-route: injection

• often intolerable adverse effects (arrhythmia, liver/bone toxicity, increase in mortality)
• -only use for acute heart failure

Question 14

Examples of Inotropic drugs (3)

Answer 14

1. Digoxin
2. Inamirone
3. Milrinone