Treatment of CHF

Question 1

NYHA class 1 clinical presentation

Answer 1

Low EF (<50%)

Question 2

NYHA class 1 treatment

Answer 2

ACE I/ARB, BB

Question 3

NYHA class 2 clinical presentation

Answer 3

DOE, edema

Question 4

NYHA class 2 treatment

Answer 4

Diuretic, ACEI/ARB, BB

Question 5

NYHA class 3 presentation

Answer 5

Dyspnea, orhtopnea, PND, edema

Question 6

NYHA class 3 tx

Answer 6

Digoxin, diuretic, ACEI/ARB, BB, spironolactone

Question 7

NYHA class 4 presentation

Answer 7

Refractory edema

Question 8

NYHA class 4 tx

Answer 8

Same as class 3 along with IV vasodilators, transplantation/assist devices

Question 9

ACEI hemodynamic effects

Answer 9

Vasodilation, decreased vent filling pressure, increased CO, reduce BP

Question 10

ACEI side effects

Answer 10

Cough, hypotension, hyperkalemia

Question 11

Contraindications/precautions of ACEI

Answer 11

Angioedema, pregnancy, renal insufficiency, hepatic insufficiency

Question 12

This ACEI has a short half life with TID dosing

Answer 12

Captopril

Question 13

Whats preferred ACE or ARB?

Answer 13

ACE… unless the patient cant tolerate the cough

Question 14

Beta receptors undergo desensitization and internalization. T/F

Answer 14

True

Question 15

What kind of dose do you use with beta blockers in CHF

Answer 15

Titrate up.. at first you see worse results, but things get better

Question 16

Which beta blockers are approved for CHF

Answer 16

Carve Met Biso: Carvedilol, Metoprolol, Bisoprolol

Question 17

Do the ACEI improve survival/prognosis?

Answer 17

YES

Question 18

What do diuretics do for the heart?

Answer 18

Reduce preload

Question 19

What two classes of diuretics are typically given for CHF

Answer 19

Loop diuretics and potassium sparing

Question 20

This drug inhibits Na/K ATPase leading to increased Ca2+ inside cells leading to a positive inotropic effect

Answer 20

Digoxin

Question 21

Indications for Digoxin

Answer 21

EF < 25%; cardiac enlargement; NYHA class 3,4

Question 22

This drug is a PDE inhibitor

Answer 22

Milrinone

Question 23

This drug is a synthetic BNP

Answer 23

Nesiritide- used for NYHA class 4