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)
