Therapeutic Strategy for HF Flashcards
What is the strategy to treat acute HF?
Fix the disruption of one of the 4 factors of cardiac performance.
- HR
- Contractility
- Preload
- Afterload
Which drugs are used to treat contractility dysfunction in acute LV systolic HF?
(+) inotropic drugs: want to increase strength of contraction
-dobutamine, DA, amrinone, milrinone, digoxin
Which drugs are used to treat contractility dysfunction in acute LV diastolic HF?
(-) inotropic drugs: decrease strength of contraction to allow better filling
-beta blockers, verapamil, diltiazam, disopyramide
Which drugs are used to reduce preload in acute HF and when should they be used?
Used in Systolic dysfunction to reduce amount of blood the “weak” heart has to pump.
-diuretics, nitrates, morphine, nitroprusside, nesiritide
MOA of nesiritide
stimulates cGMP production to maintain arterial and venous dilation
Which drugs are used to reduce afterload in acute HF and when should they be used?
Used in systolic dysfunction to reduce the force that the heart pumps against.
-nitrates, ACE-Is, ARBs, hydralazine, nesiritide
What is the treatment for acute HF due to decreased HR?
Increase HR
- pacemakers
- (+) chronotropes: atropine, isoproterenol
What is the treatment for acute HF due to increased HR?
Decrease the HR
- electrocardioversion
- (-) chronotropes: BB, digoxin, verapamil, diltiazam
What is the treatment strategy for chronic HF?
Correct the neurohormonal imbalance.
Enzyme other than ACE that converts AgI to AgII.
Chymase
What 3 meds or medication classes are used to treat chronic HF?
- ACE-I’s or ARBs
- Beta-blockers
- spironolactone
Each class influences either renin-angiotensin-aldosterone systems or the SANS
When are non-pharmacological treatments used in HF?
When the meds don’t work
When LVEF is less than 35%
QRS greater than 120ms
When is a biventricular pacemaker used in HF?
- dilated cardiomyopathy
- LBBB (or other conduction pathology)
