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9 Cards in this Set
- Front
- Back
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How do you differentiate systolic versus diastolic heart failure
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Systolic dysfunction is decreased EF >40%. Diastolic dysfunction is EF>40%
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What is the MOA of left ventricular dysfunction
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Neurohormonal activation (aldosterone, vasopressin, angiontensin II, norepi, endothelin), peripheral vasoconstriction, sodium and water retention, increased demand on the heart
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How do you manage neurohormonal blockade
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1) ACEI
Decreased mortality, decrease hospitalization. Decreases sympathetic stimulation, aldosterone and vasopressin, and decreased vasoconstriction Should be used in all patients with LV dysfunction 2) Beta blockers Decreased mortality, hospitalizations, symptom improvement May add to existing ACEI Should be used in all stable patients (those not receiving inotropes or diuretic therapy) |
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How do you manage aldosterone blockade
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Use aldosterone blockers in Class III and IV HF
Decreased mortality and hospitalizations Eplerenone in Class II may also decrease death from CV causes or hospitalization Eplerenone may also decrease mortality with LV dysfunction after MI Should be considered in all patients with Class III or IV HF who are receiving ACEI, diuretic, beta blocker or are post MI with LV dysfunction Do not use if SCr>2.5 or CLCr<30 |
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What are the benefits of digoxin in HF
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Improved symptoms, improved exercise tolerance, decreased hospitalizations. No effect on mortality
Decrease central sympathetic outflow Should be considered in patients with symptomatic LV dysfunction despite optimal ACEI, beta blocker, spironolactone or diuretic therapy Serum concentrations of 0.5-1.0 ng/dl effective Useful with concomitant AF Incresed levels with clarithromycin, erythomycin, amiodarone, dronedarone, itraconazole, voriconazole |
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What are the benefits of hydralazine-isosorbide dinitrate
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Decreased mortality and hospitalizations
Used with AA with Class II-IV HF already receiving ACEI, beta blocker and diuretics |
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What are the best ARBs to use in HF
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candesartan and valsartan
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What drugs do yuou want to avoid in HF
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NSAIDS, corticosteroids, CCB (negative inotropes, except amlodipine and felodipine), class I and III antiarrythmics (except amiodarone or dofetilide), minoxidil, TZD, metformin, anagrelide, amphetamines, cilostazol, itraconazole, pregablin
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What are the general treatment goals of diastolic dysfunction
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Control hypertension, control tachycardia (can use beta blockers, non-DHP CCB, and/or digoxin)
Use ACEI, digoxin, b eta blcokers, verapamil, diltiazem |
