Unit 1 Day 5 Flashcards
1
Q
Major Symptoms Associated with Heart Failure
A
- dec. cardiac output = -fatigue, sleepiness, wasting, reduced urine output
- inc. pulmonary venous pressure = dyspnea, orthopnea, paroxysmal nocturnal dyspnea
- inc. central venous pressure = edema, ascites
2
Q
NYHA Function Classifications
A
-based on what people can do functionally 1 = asymptomatic 2= can walk up stairs with few symptoms 3= walk up stairs with symptoms 4 = symptomatic at rest
3
Q
Signs of Low Flow
A
- cool extremities
- tachycardia
- low pulse pressure
4
Q
Signs of Inc. Left Sided Pressure
A
- rales
- hypoxia
- tachypnea
- sitting bolt upright
5
Q
Signs of Inc. Right Sided Pressure
A
- edema
- hepatic congestion/hepatomegaly
- JVD
6
Q
Heart Failure Tests and Imaging Studies
A
- chest radiography (CXR)- enlarged cardiac silhouette, acute pulmonary edema
- natriuretic peptides (BNP or NT-proBNP)- secreted by myocardium in response to ventricular stretch
- EKG- no direct diagnosis of HF
- cardiac imaging for LVEF- ultrasound, nuclear, MRI, CT
- right heart catheterization- measures pressure in various areas
7
Q
ACE Inhibitors (Angiotensin Converting Enzyme)
A
- meds in in -pril (lisinopril, enalapril, benazepril)
- block conversion of angiotensin1 to angiotensin 2
- effects: direct vasodilation, dec. aldosterone activation, salt/water excretion, most effective in sicker pts
- side effects: hypotension, worsening renal function, cough, hyperkalemia, angioedema
- drug interactions: lithium, NSAIDs, salt substitutes, loop diuretics, K+ spakring diuretics
- contraindications: pregnancy, bilateral renal artery stenosis, renal failure, angioedema, hyperkalemia
- antiremodeling
- prevents ACE breakdown of bradykinin (BK is a vasodilator)
8
Q
ARBs (Angiotensin Receptor Blockers)
A
- meds end in -sartan (valsartan, candesartan, losartan)
- effect: block receptor of angiotensin 2, salt/water excretion, potassium retention
- clinical use: equivalent to ACE1, ACE + ARB combo may provide added benefit, generally used when pts develop cough due to ACE
- side effects: ARBs, do not produce cough, similar side effects to ACE (hypotension, worse renal function, hyperkalemia, angioedema)
- contraindications: over-producers of uric acid, pregnancy, volume depletion, renal arterial stenosis, hyperkalemia
- no difference between ACE and ARB in all cause mortality
9
Q
Beta Blockers
A
- meds end in -olol (metoprolol, carvedilol, bisoprolol)
- effects: antagonize effects of sympathetic system (B adrenergic blockage), dec. contractility, best for mild to mod sx of HF
- side effects: negative inotrope (fluid retention, hypotension, dec. cardiac output), bronchoconstriction
- good for HFrEF
10
Q
Diuretics
A
- reverses fluid retention (Na Loss)
- most common HF therapy
- can be use chronically or acutely
- side effects- dehydration, hypokalemia, sulfa, tinnitis
- good for HFrEF and HFpEF
11
Q
Neurohormonal Antagonists if HFrEF
A
- ACE inhibitors
- ARBs
- MRAs
- beta blockers
12
Q
Vasodilators
A
- arterial vasodilation- dec. LV afterload, dec. cardiac work, dec. mitral regurg, dec preload and afterload
- hydralazine/isosorbide dinitrate in HFrEF in pts of african descent (can cause drug induced lupus side effect)
- vasodilation- dec. preload
- nitro
13
Q
Electrical Therapies of HFrEF
A
- Implanted cadioverter defibrillator (ICD)
- Cardiac resynchronization therapy (CRT)
- inc. contractility, HR, so inc. CO
14
Q
Positive Inotropic Agents
A
- digoxin
- dobutamine
- milrinone
- used acutely and chronically
- inc. contractility
15
Q
Mineralocorticoid Receptor Antagonists (MRA)
A
- spironolactone and eplerenone
- effects: blcok mineralocorticoid receptor (ACE/ARB aldosterone block is incomplete), Na loss
- side effects: hyperkalemia, gynecomastia (spiro)
16
Q
Tx for Chronic HFrEF (LVEF <40%)
A
- BB
- ACE/ARB
- aldosterone antagonist
- hydralazine/ISDN
- +/- digoxin
- ICD/CRT
17
Q
Tx for Acute HFrEF (LVEF < 40%)
A
- IV diuresis
- nitrates (if BP allows)
- CPAP/BiPAP (if SOB)
- pressors (if dec. CO, shock)
18
Q
Tx for Chronic HFpEF (LVEF > 40%)
A
- control risk factors (DM, HTN, obesity)
- control volume status (?)
19
Q
Tx for Acute HFpEF
A
- IV diuresis
- nitrates (if BP allows)
- CPAP/BiPAP
20
Q
HF Prevention Goals
A
- hypertension
- diabetes
- hyperlipidemia
- physical inactivity
- excessive OH intake
- smoking
- dietary sodium
21
Q
Digoxin
A
- mechanism of action: blocks Na/K pump ATPase, inotrope (INC CONTRACTION), slows rate of SA node, SLOWED CONDUCTION of AV node (causes activation of the Na/Ca pathway and causes calcium to enter the cell) (prolongs phase 0 and phase 4)
- inc. contraction in HFrEF, and is antiarrhythmic in supraventricular arrhythmias
- metabolism: oral or IV administration, renally eliminated, 38 hr half life (steady state 7-10 days)
- side effects/toxicity: hypokalemia, hypercalcemia, hypomagnesemia, nausea, vomiting, weakness, confusion, bradycardia, arrhythmia, visual changes
- sometimes extreme toxicity includes severe arrhythmia, bradycardia, heart block unresponsive to atropine, inc. K+
- drug-drug interactions: quinidine, verapimil, amniodarone, propafinone, itraconazole, macrolide antibiotics
- reduces number of pts hospitalized
- from foxglove plant
- reverse toxicity w/ digoxin immune fab
22
Q
Dobutamine
A
- mechanism of action: beta1 agonist to inc. contractility, slight peripheral vasodilation
- metabolism: 2 min half life
- side effects/toxicity: angina, arrhythmia, dysrhythmia
- drug-drug interactions: beta 1 agonist- not helpful if also taking beta blockers
- not recommended if hypotensive
23
Q
milrinone
A
- mechanism of action: PDE (phosphodiesterase degrades cAMP) inhibitor, augments Ca utilization, moderate peripheral vasodilation
- inotrope, vasodilator
- metabolism: 1-3 hr half life
- side effects/toxicity: hypotension, thrombocytopenia, tachycardia, arrhythmias, fever, inc. LFTs
- drug-drug interactions: recommended if receiving beta blocker
24
Q
dopamine
A
- mechanism of action: endogenous precursor of norepinephrine directly stimulates adrenergic receptors
- causes inotropy
- metabolism: dose dependent effect, continuous infusion via pump
- proarrhythmic
- side effects/toxicity: none listed
- drug-drug interactions: none listed
25
Q
HFrEF
A
-systolic dysfunction
26
Q
neprilysin inhibitors
A
- new
- prodrug
- inhibits neprolysin
- neprilysin normally degrades BNP (BNP is good for tx in HF)
- also blocks angiotensin 2 receptor
27
Q
aldosterone
A
- activated by angiotensin 2
- causes water retention
- inc. HR
- activates sympathetic nervous system
