Treatment of CHF Flashcards
NYHA class 1 clinical presentation
Low EF (<50%)
NYHA class 1 treatment
ACE I/ARB, BB
NYHA class 2 clinical presentation
DOE, edema
NYHA class 2 treatment
Diuretic, ACEI/ARB, BB
NYHA class 3 presentation
Dyspnea, orhtopnea, PND, edema
NYHA class 3 tx
Digoxin, diuretic, ACEI/ARB, BB, spironolactone
NYHA class 4 presentation
Refractory edema
NYHA class 4 tx
Same as class 3 along with IV vasodilators, transplantation/assist devices
ACEI hemodynamic effects
Vasodilation, decreased vent filling pressure, increased CO, reduce BP
ACEI side effects
Cough, hypotension, hyperkalemia
Contraindications/precautions of ACEI
Angioedema, pregnancy, renal insufficiency, hepatic insufficiency
This ACEI has a short half life with TID dosing
Captopril
Whats preferred ACE or ARB?
ACE… unless the patient cant tolerate the cough
Beta receptors undergo desensitization and internalization. T/F
True
What kind of dose do you use with beta blockers in CHF
Titrate up.. at first you see worse results, but things get better
Which beta blockers are approved for CHF
Carve Met Biso: Carvedilol, Metoprolol, Bisoprolol
Do the ACEI improve survival/prognosis?
YES
What do diuretics do for the heart?
Reduce preload
What two classes of diuretics are typically given for CHF
Loop diuretics and potassium sparing
This drug inhibits Na/K ATPase leading to increased Ca2+ inside cells leading to a positive inotropic effect
Digoxin
Indications for Digoxin
EF < 25%; cardiac enlargement; NYHA class 3,4
This drug is a PDE inhibitor
Milrinone
This drug is a synthetic BNP
Nesiritide- used for NYHA class 4
