Treatment of Heart Failure

Question 1

describe the four classes of NYHA HF ratings

Answer 1

class I- asymptomatic
class II- symptomatic with moderate exertion
class III- symptomatic with minimal exertion
class IV- symptomatic at rest

Question 2

name three common symptoms of RHF

Answer 2

distended jugular veins
hepatomegaly
peripheral edema

Question 3

name three common symptoms of LHF

Answer 3

pulmonary rales
S3/S4 gallops
orthopnea

Question 4

what is orthopnea?

Answer 4

dyspnea that occurs when lying flat and is relieved when sitting up

Question 5

name the most common cause of RHF

Answer 5

right heart failure from left heart failure

Question 6

explain how left heart failure can lead to right heart failure

Answer 6

the increased pressure in the left can eventually lead to increased pressures in pulmonary arteries and that will therefore increase the afterload on the right heart

Question 7

what is the usual cause of HFpEF

Answer 7

diastolic dysfunction…heart cannot fill properly but contractility is still the same

Question 8

what does a negative BNP with dyspnea tell you about heart failure?

Answer 8

it is a strong indicator that the patient is not experiencing heart failure

Question 9

name the two important effects of ACE/ARBs with HF

Answer 9

neurohormonal effects and hemodynamic effects

Question 10

explain the hemodynamic effect of ACE/ARB with HF

Answer 10

decreased SVR and BP leads to a lower afterload on the myocardium

Question 11

explain the neurohormonal effects of ACE/ARB with HF

Answer 11

decreased fibrosis due to decreased water retention and sympathetic tone

Question 12

what is the common combo ACE/ARB to give patients with HF

Answer 12

Entresto…combo of sacubitril and valsartan

Question 13

name the two aldosterone antagonists that can be given in HF

Answer 13

spiranolactone and eplerenone

Question 14

name two side effects of spiranolactone

Answer 14

gynecomastia and hyperkalemia

Question 15

name the two beta blockers used with HF

Answer 15

metoprolol and carvedilol

Question 16

how does digoxin/digitalis work?

Answer 16

blocks the Na/K ATPase and causes Ca retention so you have more contractile force in myocardium

Question 17

what is the issue with digoxin?

Answer 17

very narrow treatment window to toxicities

Question 18

what is the drug of choice to give to lessen fluids in HF?

Answer 18

furosemide…the loop diuretic (most potent)

Question 19

what is a combo drug that includes hydralizine for treatment of HF?

Answer 19

BiDil

Question 20

do diuretics increase life expectancy with HF?

Answer 20

NO…just improve QOL

Question 21

what can we give patients who are at high risk for life threatening arrhythmias

Answer 21

ICDs

Question 22

what do we give someone with a big LBBB or QRS over 120 ms and have HF?

Answer 22

cardiac resycnronization therapy

Question 23

define cardiac resynchronization therapy

Answer 23

bi ventricular pacing of the heart when there is a large LBBB or severely enlarged QRS over 120 ms

Question 24

all the drugs besides loop diuretics increase life expectancy in the case of which type of HF?

Answer 24

not preserved ejection fraction

Question 25

are there any drugs that increase survival of HFpEF

Answer 25

NO

Question 26

what is best treatment for HFpEF since no drugs decrease mortality?

Answer 26

weight loss..can give drugs to help relieve issues

Question 27

what are the cold symptoms of acute decompensated HF?

Answer 27

cardiogenic shock including nausea, early satiety, altered mental status, acidosis, reduced capillary refill. hypotension, cold skin

Question 28

if you have cold symptoms what does it indicated about your cardiac output?

Answer 28

you have a low CO

Question 29

what are the wet symptoms of acute decompensated HF?

Answer 29

dyspnea orthopnea PND morning cough, peripheral edema, rales, ascites, hepatic congestion

Question 30

if you are “wet” what does this indicate about your HF?

Answer 30

have a high pulmonary wedge capillary pressure…indicative of a high preload

Question 31

name the three treatments for being cold and wet

Answer 31

diuretics, vasodilators, inotropes

Question 32

name the three treatments for being cold and dry

Answer 32

inotropes, vasodilators, and maybe an IABP

Question 33

name the treatment for being warm and wet?

Answer 33

diuretics

Question 34

describe the treatment for being warm and dry

Answer 34

maintain optimal oral therapy as prescribed for outpatient setting

Question 35

what are inotropes and when are they used to treat HF?

Answer 35

inotropes are beta agonists pretty much and they are used when CO is severely decreased and the person is “cold”

Question 36

name the two inotropes used in HF treatment

Answer 36

dobutamine and Milrinone

Question 37

what is the issue with recurrent use of inotropes in HF treatment

Answer 37

increases risk of Ventricular arrhythmias…so dont want to keep them on inotropes permanently if possible