Heart Failure

Front 1

ACC/AHA staging system

Back 1

A. at risk of developing HF

B. structural heart disease present but w/o s&sx of HF.

C. structural heart disease present w/ prior or current symptoms of HF.

D. advance structural heart disease w/ symptoms of HF at reast despite max medical therapy.

Front 2

NYHA fx class

Back 2

1. no limitation on physical activity. ordinary physical activity doesn't cause symptoms.

2. slight limitation on physical activity. comfortable at rest, but ordinary physical activity results in symptoms of HF.

3. Marked limitation of physical activity. Comfortable at rest. minimal exersion cause symptoms of HF.

4. unable to carry any physical activity w/o symptoms of HF, or symptoms of HF at rest.

Front 3

Avoid

Back 3

NSAIDs and Cox 2 inhibitors in HF patient.

Front 4

Cornerstone of HF treatment

Back 4

diuretic, ACEi/ARB, Beta blocker

Front 5

Loop diuretic

Back 5

MOA: work at ascending loop of henle, increase excretion of Na, Cl, Mg, Ca, and H2O.

-lowest effective dose should be used.

-CI: anuria

-Warning: sulfa allergy(not likely to cross react)

-SE: hypokalemia, ortho hypotension, decrease in Na, Cl, Mg, Ca, photosensitivity, hyperglycemia, hypertryglycermia,

-furosemide IV:PO ratio is 1:2, bumetanide, torsemide, and ethacyrnic acid IV:PO 1:1

Front 6

Demadex

Back 6

torsemide

loop diuretic

preg cat B

Front 7

Lasix

Back 7

furosemide

loop diuretic

preg cat C

Front 8

ACEi/ARB

Front 9

Beta blocker for HF

Back 9

metoprolol succ(Toprol XL)

bisoprolol (Zebeta)

carvedilol (Coreg)

SE: hypotension, fatique, dizziness, depression, decrease in libido

avoid abrupt d/c.

recommended in all pt.

Only these are used in HF .

Front 10

Hydralazine/Nitrate

Back 10

MOA: direct vasodilator

alternative therapy for pt can't tolerate ACEi/ARB or black pt.

NYHA 3-4 or symptomatic after optimal treatment w/ ACEi.

CI: PDE-5 inhibitors

warning: drug induced lupus erythematosus

SE: headache, dizziness, hypotension, tachycardia

Front 11

BiDil

Back 11

isorsorbide dinitrate/hydralazine

direct vasodilator

Front 12

Hydralazine

Back 12

direct vasodilator

Front 13

Monoket

Back 13

isosorbide mononitrate

direct vasodilator

CI w/ PDE5 inhibitor

Front 14

Digox, Lanoxin

Back 14

digoxin

-MOA: inhibit Na/K atpase pump, results in positive inotropic effect.

-improve symptoms, exercise tolerance, and quality of life but doesn't improve survival of pt. does reduce hospitalization for heart failure.

-dosage should account for renal fx.

-Toxicity: signs include n/v, loss of appetite, bradycardia, blurred vision, confusion, delirium, arrhythmia.

-Antidote: DigiFab

-hypokalemia, hypomagnesemia, hypocalcemia increase risk of toxicity.

Front 15

Potassium chloride

Back 15

-hypokalemia often cause by loop.

-check mg before K+.

-CI: severe renal impairment, hyperkalemia, GI obstruction.

-Note: take with meal with full glass of water to prevent GI upset.

-Micro-K capsule can be open and sprinkle onto apple sauce.

Front 16

ADHF treatment

Back 16

-nitroglycerin(most common)

-Nitroprusside(Nitropress): can cause cyanide toxicity, discouraged in MI, can cause coronary steal.

-nesiritide(Natrecor): no evidence of mortality , thus not commonly used.