Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
37 Cards in this Set
- Front
- Back
|
Role of compensatory mechanisms in HF
|
contribute to the problem
increase sympathetic tone--increase release of Norepi decreased perfusion--RAAS activation |
|
|
What did the V-HEFT 1 study find?
|
Mortality dramatically incrased w/increasing plasma norepi levels.
|
|
|
Valsartan
|
Angiotensin receptor blocker use when pt. is intolerated of ACEi.
|
|
|
What did the Val-Heft study find?
|
w/combination of ACEi and beta blocker, and ARB pts. did worse than those getting only two.
Excess (-) of the SNS is undesirable |
|
|
What is the cardinal symptom of HF?
|
Effort intolerance
|
|
|
NYHA Classification for HF
|
Class 1- no symptoms
Class 2- Symptoms w/normal activity Class 3- Symptoms w/less than ordinary activity Class 4- Symptoms @ rest |
|
|
Which drugs improve effort intolerance but don't prolong life? Which does both?
|
Vesnarinone and + inotropes
Digoxin |
|
|
What is fluid retention caused by?
|
Na and H2O retention due to RAAS activation
|
|
|
What does increased pulmonary venous pressure (as in edema) cause?
|
Dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea
|
|
|
Treatment for HF associated edema?
|
Early- ACEi
Later- digoxin |
|
|
Loop diuretic commonly used? Why use caustion when using it to treat HF?
|
Furosemide
Hypokalemia can develop |
|
|
Why avoid K supplements w/ACEi?
|
Lethal hyperkalemia (ck pts. for salt-substitue use)
|
|
|
Drugs used in end-stage HF for edema
|
1)low dose DA (increase renal perfusion)
2) Morphine (vasodilation) |
|
|
How many people does HF affect/yr? What is the 5 year mortality rate?
|
500,000
60% in men 45% in women |
|
|
Does sudden arrythmic death happen more to class 2 or class 4 people
|
Careful! Class 2 people
|
|
|
What signs are worrisome in HF pts?
|
Syncope or near syncope
ventricular ectopy on EKG |
|
|
What did the MADIT-2 study show?
|
Pts with EF <30% and hx of MI have 30% lower death rate @ one year if they recieve a defribillator
|
|
|
What drugs reduce the risk of sudden death?
|
ACEi
Spironolactone Beta-blockers |
|
|
Which drugs reduce risk of progressive pump failure?
|
ACEi
Beta blockers ARAS (possibly) |
|
|
The approach to HF pts.
|
Prevent
Prove prescence of Lft. Ventricular dysfxn Classify dysfxn as sys. or dias. *must have echo, nucleotide study, or angiogram Seek correctable cause Treat (try to prolong life) |
|
|
Standard of care used to classify LV dysfxn
|
Echo
Nucleotide study Angiogram |
|
|
Name 5 causes of correctable HF
|
Sarcoid
Hemochromatosis Hyper/hypothyroidism SLE Beri Beri |
|
|
What treatment goal is essential for systolic dysfxn?
|
Afterload reduction
|
|
|
Recommendations for pts. w/sys dysfxn.
|
Normalize BP
Reduce EtOH Increase K intake AVOID unnecessary NSAIDS |
|
|
Class 1 Drugs
|
ACEi
|
|
|
Therapeutic Goal for Class 1
|
Reduce BP (prevent LV dilation, supress RAAS)
|
|
|
Toxicities of Class 1 drugs
|
Cough
Allergic Pneumonia |
|
|
Class 2 drugs
|
ACEi
ARB (if ACEi not tolerated) Na restriction Beta blockers* Consider digoxin (nitrates) |
|
|
Therapeutic Goal of Class 2
|
Treat ischemia
|
|
|
Toxicities of Class 2 drugs
|
Bradycardia*
Arrhytmias (increase in hypoK and renal failure) |
|
|
Class 3 drugs
|
ACEi
ARB Beta Blocker* Digoxin* (nitrates) Na restriction Diuretics |
|
|
Therapeutic guidelines for Class 3 drugs
|
Titrate upwards
Spironolactone is first line for diuretics |
|
|
Toxicities of Class 3 drugs
|
Can worsen sys. dysfxn at first
Watch serum K+!! |
|
|
Class 4 drugs
|
ACEi
ARB Consider Beta blockers Digoxin (Nitrates) Na/H2O restricion Diuretics Periodic ionotropes |
|
|
Most common error in mangement of HF
|
Inducing bradycardia w/xs Beta blockade
|
|
|
Four other errors in managing HF
|
Hypokalemia (xs diuretics)
Hyperkalemia (K+ sparing diuretics + ACEi) Acute renal failure (NSAIDS + ACEi) Digoxin toxicity |
|
|
What level of digoxin should you aim for?
|
O.5-0.8 ng/ml
|
