(THER) Treatment for CHF

Question 1

Common causes of acute CHF (7)

Answer 1

1. Acute MI
2. Ischemia
3. Myocarditis
4. Acute Regurg
5. Arrhythmias
6. Acute Tamponade
7. Massive PE

Question 2

Common causes of chronic CHF (3)

Answer 2

1. Ischemic Cardiomyopathy (most common cause)
2. Hypertrophic Cardiomyopathy
3. Dilated Cardiomyopathy

Question 3

Treatment Objectives in Acute CHF (2)

Answer 3

1. Early recognition/treatment
2. Decrease symptoms (i.e. reduce pulmonary congestion and increase CO)

Question 4

What treatment is the key to the reduction of Pulmonary Congestion in Acute CHF?

Answer 4

Diuretics

Question 5

When patients are given diuretics, preload decreases. How does this change affect CO in patients with CHF?

Answer 5

Because the curve is relatively flat for patients in CHF, preload reduction via diuretics may have little effect on CO.

Question 6

Niseritide MOA and effect

Indication?

Answer 6

It is a Human Recombinant Brain Natriuretic Peptide (hBNP)

Normally BNP is produced by ventricular myocardium in response to chronic stress. This drug causes vasodilatation and decreases Na reabsorption (natriuresis).

Used for CHF

Question 7

How is contractility affected in many forms of acute CHF?

Answer 7

It is decreased

Question 8

What drug types are used to counter the loss of contractility in many CHF types?

Answer 8

1. Beta Adrenergic Agonists
2. Phosphodiesterase Inhibitors

These both serve as inotropic agents

Question 9

Name the Phosphodiesterase Inhibitors (2)

Answer 9

1. Inamrinone (aka Amrinone)
2. Milrinone

Question 10

Nonpharmacological Therapy for Acute CHF

Answer 10

1. PCI/Surgical Therapy
2. Ultrafiltration
3. Intra-aortic Balloon Pump
4. Ventricular Assist Device (such as an LVAD)

Question 11

Main Treatment objectives in Chronic CHF (4)

Answer 11

1. Early recognition of ventricular dysfunction (even in the absence of symptoms)
2. Prevent Ventricular Remodeling
3. Decrease Symptoms (reduce pulmonary congestion/ increase CO)
4. Prolong Survival

Question 12

Which arteriolar vasodilators are used most clinically for chronic CHF?

Answer 12

ACE inhibitors and ARBs

Both are key in prevention of remodeling

Question 13

What is LCZ696? What 2 things does it combine?

Answer 13

It is the newest chronic CHF medication.

It is a combination of valsartan (an ARB) and Sacubitril (A Neprilysin Inhibitor)

Question 14

What is the MOA of LCZ696? (2)

What does this ultimately lead to?

Answer 14

1. Its Valsartan component blocks AT1a (angiotensin 1a) receptors on cardiac and vascular smooth muscle cells
2. Its Sacubitril (neprilysin inhibitor) component blocks enzymes which degrade natriuretic peptides, bradykinin and adrenomedullin

These lead to vasodilation and reduction of ECF volume via sodium excretion

Question 15

Nonpharmacological Therapy for Chronic CHF

Answer 15

1. Surgical Therapy
2. LVAD
3. Biventricular Pacing/implantable cardioverter defrillator
4. Cardiac transplantation