Tx of CHF

Question 1

What are the treatment objectives in acute CHF?

Answer 1

1) Early recognition and treatment of contributing factors

2) Decrease symptoms (reduce pulmonary edema and increase CO)

Question 2

What is the difference between nitroglycerin and nitroprusside?

Answer 2

Nitroglycerin is more of a venodilator, whereas nitroprusside is a potent arterial and venous vasodilator (it produces more balanced arterial and venous dilation). Nitroglycerin is used to reduce edema, whereas nitroprusside is used to increase CO by reducing afterload.

Question 3

___________ reduce pulmonary congestion in acute CHF.

Answer 3

diuretics (specifically, loop diuretics)

Question 4

When treating acute heart failure with diuretics, what should you do if a patient is resistant to a furosemide?

Answer 4

combine with a thiazide diuretic

Question 5

What are the inotropic agents used to treat acute CHF?

Answer 5

• Beta agonists (dobutamine, NE, dopamine)

- Phosphodiesterase inhibitors (inamrinone, milrinone)

Question 6

What is the added benefit of using a PDE?

Answer 6

PDEs also

Question 7

What are the treatment objectives in chronic CHF?

Answer 7

1) Early recognition of LVD
2) Prevent ventricular remodeling**
3) Decrease symptoms (reduce pulmonary congestion/edema and increase CO)
4) Prolong survival

Question 8

________ improve survival in chronic LV dysfunction and CHF by slowing CHF progression and reducing mortality.

Answer 8

ACE inhibitors (when combined w/ Digoxin and diuretics)

Question 9

What is the “newest” chronic CHF medication?

Answer 9

LCZ696 (combination of Valsartan and Sacubitril) - also known as ARNI

Question 10

What are the actions of cAMP in cardiac muscle?

Answer 10

• increased opening of L-type Ca2+ channels (inotropy)
• increased reuptake of Ca2+ into SR stores (inotropy and lusitropy)
• increased pacemaker current (chronotropy)
• increased conduction rate (dromotropy)

Question 11

How can ventricular remodeling be prevented in CHF?

Answer 11

Anything that blocks renin-angiotensin-aldosterone system!

• ACE inhibitors/ARBs/LCZ696
• Beta blockers
• Aldosterone antagonists

Question 12

True or false: Inotropic agents must be given in the setting of CHF.

Answer 12

False! We want to avoid inotropic agents because they can precipitate remodeling. Instead, digitalis is used as a last-ditch effort if CO cannot be increased in another way.

Question 13

________ is a potent cardiomyocyte growth factor (hypertrophy) and fibroblast mitogen (hyperplasia).

Answer 13

Angiotensin II

Question 14

How do ACE inhibitors reduce ventricular hypertrophy/remodeling?

Answer 14

They reduce systolic and diastolic wall stress, thereby decreasing stretch-induced remodeling.

Question 15

What can be used for patients intolerant to ACEIs?

Answer 15

ARBs (losartan, valsartan, candesartan)

Question 16

Why must beta blockers be used with caution in patients with CHF?

Answer 16

beta blockers result in decreased contractility, which is already an issue for CHF patients

Question 17

How do arteriolar vasodilators increase CO?

Answer 17

by reducing afterload (same beneficial effects as inotropes)

Question 18

Why are Ca2+ channel blockers contraindicated in acute CHF?

Answer 18

CCBs have negative inotropic effects (and HF patients already have problems with CO)

Question 19

What are digitalis glycosides mainly reserved for clinically?

Answer 19

to slow ventricular rate in patients with CHF and atrial fibrillation with rapid ventricular response

Question 20

What is the cardiac toxicity associated with digitalis?

Answer 20

• DADs and abnormal automaticity

- Digitalis intoxication (VPBs, Vtach, junctional tachycardia)