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29 Cards in this Set

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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