Treatment of CHF Flashcards
What are the common causes of acute CHF?
- Acute MI
- Global Myocardial Ischemia
- Viral Myocarditis
- Acute Valvular Regurgitation
- Arrhythmia (VT/VF)
- Acute Pericardial Tamponade
- Massive Pulmonary Embolism
What are common causes of chronic CHF?
- Ischemic Cardiomyopathy
- Hypertrophic Cardiomyopathy
- Dilated Cardiomyopathy
What is the most common cause of CHF in the US?
Ischemic Cardiomyopathy
What are the treatment objectives in Acute CHF?
- Early recognition
- Reduce pulmonary congestion
- Increase CO
What is used to treat pulmonary congestion?
Loop diuretics and venodilators (nitroglycerin)
How do diuretics affect pulmonary congestion?
Reduces volume which will reduce the preload and the pulmonary venous pressure and pulmonary edema.
Why do diuretics have little effect on CO output on patients with acute CHF?
Preload reduction may have little effect because patient in CHF will have a very flat Frank Starling curve making changes in the LVEDP have little impact on the CO
How do nitrates alleviate pulmonary congestion?
Venodilation will decrease the venous return to the heart which will lead to the reduction of pulmonary symptoms.
Nisertide MOA
hBNP and it activates smooth muscle NPR1 and 2 which raises cGMP causing vasodilation and decreases Na reabsorption in the DT
What are the drugs use to increase inotropy in acute CHF?
Beta Adrenergics
Phosphodiesterase Inhibitors
How does nitroprusside increase CO?
Reduces afterload
What are the treatment objectives in chronic CHF?
- Prevent ventricular remodeling
- Reduce pulmonary congestion and edema
- Increase CO
- Prolong survival
Digitalis Glycoside MOA
Partial inhibition of Na/K ATPase leads to increase [Na] intracellularly which will enhance the Na/Ca exchange, increasing [Ca] in the cell and stored in the SR.
More Ca is release from the SR with each contraction increasing the contractility.
Digitalis Glycoside SE
- Delayed afterdepolarizations (DAD’s) and abnormal automaticity - arrhythmias
Digitalis Glycoside Indications
Because of potential for side-effects, digoxin is now primarily used in patients with CHF and Atrial Fibrillation with rapid ventricular response
What is used to reverse digitalis toxicity?
Digibind antibodies used to treat life-threatening Digitalis Toxicity
What are the vasodilators used for acute CHF?
- Nitroprusside
- Nitroglycerin
What are the vasodilators used for chronic CHF?
- ACE Inhibitors
- Angiotensin II Receptor Blockers
- Hydralazine
- Minoxidil
- Prazosin
How do ACE inhibitors improve survival in CHF?
Prevent ventricular remodeling
What is the MOA of ACE-I in prevention of ventricular remodeling?
- Angiotensin II is a potent cardiomyocyte growth factor (hypertrophy) and fibroblast mitogen (hyperplasia)
- Inhibition of local RAAS System (autocrine/paracrine
effects) - ACE Inhibitors also reduce systolic and diastolic wall stress, decreasing stretch-induced hypertrophy and remodeling
What is LCZ696?
Combination of Valsartan (An ARB) and Sacubitril
LCZ696 MOA
- Valsartan blocks AT1a receptor on cardiac and vascular smooth muscle.
- Sacubitril is converted into a neutral endopeptidase inhibitor. Neutral endopeptidases degrade natriuretic peptides, bradykinin, and adrenomedullin. Thus, sacubitril increases the levels of these peptides, causing vasodilation and reduction of ECF volume via sodium excretion.
What is “Destination Therapy?”
LVADs given to patients who are not candidates for heart transplants and it is used to carry on their life as far as it can go
What agents have been proven to improve survival in chronic CHF?
- Carvedilol
- Spironolactone
