• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/31

Click to flip

31 Cards in this Set

  • Front
  • Back
Heart Failure vs CHF
“Congestive Heart Failure” usually denotes a volume overloaded status

Because not all patients have volume overload at
the time of the evaluation, “congestive heart failure” should be distinguished from the broader term “heart failure
Describe stages of heart failure.
A: at risk, no syx; high risk for developing HF, no strutrual heart dz; pts with HTN, DM< HypLip, Obesity, risky bhvr (smoking)

B: structural heart dz present, but no syx (e.g., asyx LV dysfn)

Stage C: past or current syx of HF

Stage D: End-stage HF
Ideal BP and pulse.
BP under 130/80
Resting heart rate <63 bpm
What drugs can cause or worsen heart failure?
NSAIDs
antiarrythmics
adriamycin
Drug treatment for Stage A.
ACE Inhibitor (multiple trials show decreased mortality with use of ACE-i's)
Angiotensin Receptor Blocker (about equivalent efficacy to ACE-i)
ACE Inhibitors:
Adverse Events
Dry cough
Hypotension (start with low doses)
Valsartan:
Drug Class
Angiotensin Receptor Blocker
Candesartan:
Drug Class
Angiotensin Receptor BLocker
Drug treatment for Stage B.
Same as Stage A (preventive measures)

ACE-i and/or ARBs
Beta-blockers
Beta-blockers:
Mechanism
Dec'd symp output (renin, NE, epi)
Dec heart rate contractility
Beta-blockers:
AEs
Contraindications
Hypotn
Fluid retention/worsening heart failure
Fatigue
Bradycardia/heart block

Discontinue only in severe cases

Contraindications:
Severe COPD, asthma
Severe peripheral vascular dz (need extra cardiac output to diffuse distal limbs)

(symptoms may worsen in 4-10 weeks with beta-blockers; always start with low douse and double every 2-3 weeks until target reached)
Carvedilol:
Drug Class
Beta-blocker
Metoprolol:
Drug Class
Beta-blocker
Bisoprolol:
Drug Class
Beta-blocker
Drug Therapy for Stage C
General measures as advised for Stages A and B

Diuretics for fluid retention
ACE-i
Beta-blockers
Symptoms of Stage C heart disease. Treatment for each (general).
Hypotn, fatigue (must inc cardiac output by inc contractility via inotropes, must dec afterload: ace-i/arb's, hydralazine)

Water retention, pulmonary congestion (must dec preload): Nitrates
Diuretics
ACE-i/ARB’s
Main goal of diuretics.
Decrease preload

Relieve syx of congestion (dyspnea, orthopnea, paroxysmal nocturnal dyspnea)
Furosemide:
Drug Class
Loop diur
Bumetanide:
Drug Class
Loop diur
Torsemide:
Drug Class
Loop Diur
Loop vs Thiazide Diuretics
Loop: More potent for CHF; effective in renal dysfn

Thiazide: sustained action against HTN; vascular dilation after long term use
HCTZ:
Drug Class
Thiazide diur
Metolazone:
Drug Class
Thiazide diur
Ethacrinic Acide:
Drug Class
Thiazide diur
Spironolacotne:
Drug Class
Aldosterone antag (diuretic)
Eplerenone:
Drug Class
Aldosterone antag (diuretic)

(blocks aldost to prevent Na+ retention and thus lose water)
Aldosterone Inhibiors:
AEs
HYPERkalemia
Digitalis:
Use
Effects
AEs
Select patients with Stage C heart Dz

Enhance vagal tone, enhance slows conduction at AV node; reduces hospitalizations for people with heart failure (won't reduce overall mortality)

AEs:
Excreted by kidney
Narrow therapeutic range
Toxicity enhanced by quinidine, amiodarone (!), Low K-Mg

Arrythmias (brady and tachy)
CNS EFFECTS!!!
Dizziness, confusion, visual disturbances, blurry vision, HALO effect around lights
Hydralazine:
Use
Effects
AEs
Select Stage C pts

Reduces Afterload; improves survival in AAs (when combined with isosorbide--a nitrate)

Should be considered as an alternative therapy in all other patients who are:
Persistently symptomatic despite ACE-i and beta-blocker
Intolerant to ACE-i or ARB’s (e.g. renal failure)
Stage C patients with reduced LVEF and symptoms:
Therapy
ICDs in appropriate pts
Cardiac resynch in appropriate pts
Exercise training, testing

look at summary slide...
Stage D:
Therapy
Control fluid retention to relieve syx
(diuretics may worsen condition if pt has kidney failure)
Heart transplant, valve repair
End-of-life care

Prolongation of survival (diuretics, beta-blockers, ACE-i's, inotropes, ARBs)

Inotropic therapy (digoxin, digitoxin, amrinone, milrinone, DA, dobutamine, NE, Epi}sympathomimetic amines)