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;
29 Cards in this Set
- Front
- Back
|
NYHA Class I HF
|
Patients with cardiac disease but without limitations of physical activity
|
|
|
NYHA Class II HF
|
Cardiac disease that results in slight limitations of physical activity. ordinary activity results in fatigue, palpitation, syspnea or angina
|
|
|
NYHA Class III HF
|
Cardiac disease that results in marked limitation of physical activity. Less than ordinary activity leads to symptoms
|
|
|
NYHA Class IV HF
|
Cardiac disease that results in inability to carry on physical activity without discomfort. Symptoms present even at rest
|
|
|
Stage A HF
|
High risk of developing heart failure: Previous MI, left ventricular atrophy
|
|
|
Stage B HF
|
Patients who have developed structural heart disease, but never show signs of heart failure
|
|
|
Stage C HF
|
current or prior symptoms of heart failure: dyspnea, fatigue
|
|
|
Stage D HF
|
Advanced structural heart disease and marked symptoms of heart failure at rest, despite maximal medical therapy
|
|
|
Warm and dry heart failure
|
Adequate perfusion (cardiac output) and no signs of volume overload
|
|
|
Warm and wet heart failure
|
Adequate perfusion, but signs or symptoms of volume overload
|
|
|
Cold and dry
|
Inadequate perfusion and no signs or symptoms of volume overload
|
|
|
Negative inotropic drugs
|
Antiarrhythmics: disopyramide, flecainide, propafenone
Beta Blockers CCBs: verapamil, diltiazem Oral antifungals: Itraconazole, terbinafine |
|
|
Sodium and water retention drugs
|
NSAIDs
Glucocorticoids Rosiglitazone and pioglitazone |
|
|
Heart failure diagnostic tests
|
B-type natriuretic peptide (BNP)
ECG left ventricular ejection fracton <40% = systolic dysfunction |
|
|
Loop diuretics in heart failure
|
Most heart failure patients require more potent loop diuretics vs. thiazide diuretics
|
|
|
ACE Inhibitors in Heart failure
|
These are a cornerstone of therapy in heart failure. All heart failure due to left ventricular systolic dysfunction should receive and ACEI unless contraindicated
|
|
|
Beta Blockers in heart failure
|
negative inotropes, but inhibit deleterious effects of long-term activation of the sympathetic nervous system in heart failure. Decrease mortality
Should be used in combo with diuretics and ACEIs |
|
|
Digoxin in heart failure
|
Does not improve mortality, but does improve symptoms
|
|
|
Digoxin Mechanism of action
|
Inhibits Na/K-ATPase pump - increases intracellular calcium, and causes a positive inotropic effect
|
|
|
Digoxin counseling
|
Contact Dr. if following occur
Dizziness, fatigue Changes in vision irregular heartbeat loss of appetite |
|
|
Digoxin Adverse drug events
|
Cardiovascular: cardiac arrhytmias, bradycardia, heart block
GI: anorexia, abdominal pain, N/V Neruological: visual disturbances, confusion, fatigue |
|
|
Digoxin toxicity
|
Toxicity associated with serum dig. conc. >2 ng/ml, but may occur at lower levels if hypokalemic, hypomagesemic, and elderly
|
|
|
Digoxin Drug interactions - Drugs that increase serum digoxin levels
|
Quinidine, verapamil, amiodarone - decrease dose 50%
Propafenone Flecainide Macrolides: Emycin, clarithromycin Itraconazole, ketoconazole Spironolactone Cyclosporine |
|
|
Drugs that decrease serum digoxin levels
|
Antacids
Cholestyramine/Colestipol Kaolin-pectin Metoclopramide |
|
|
Digoxin monitoring
|
Serum concentration (0.5-1.0)
Heart rate Serum potassium adn magnesium BUN/SCr Heart failure symptoms |
|
|
ARBs in Heart failure
|
Not to be substituted for ACEI unless intractable cough or angioedema
Only valsartan and candesartan are approved for use in heart failure |
|
|
Aldosterone antagonists in Heart failure
|
Spironolactone and eplerenone
Add these in patients with recent or recurrent symptoms at rest despite use of digoxin, diuretics, ACEI and BB. |
|
|
Hydralazine-Isosorbide Dinitrate in Heart failure
|
Can be considered in patients with problems with ACEI
When added to ACEI, BB, diuretics and digoxin in blacks, reduce mortality |
|
|
Beta Blockers in heart failure - Proven agents
|
Bisoprolol
carvedilol Metoprolol Extended Release |
