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22 Cards in this Set
- Front
- Back
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Systolic dysfuntion
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Heart failure w/ reduced ejection fraction
EF < 40% |
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Diastolic dysfunction
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Heart faliure w/ preserved ejection fraction
EF is mildly reduced or normal |
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General s/s of Heart Failure
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Dyspnea at rest or on exertion
Weakness/fatigue, SOB Reduction in exercise capacity Left ventricle hypertrophy Increased BNP and NT-proBNP levels |
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S/s of left-sided Heart Failure
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Orthopnea
Paroxysmal nocturnal dyspnea or nocturnal cough Biasilar rales S3 gallop EF < 40% |
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S/s of right-sided Heart Failure
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Edema
Ascites Jugular venous distention Hepatojugular reflex Hepatomegaly |
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Heart Failure Lifestyle Changes
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Sodium restriction < 1500 mg/d
Fluid restriction (in stage D) Smoking cessation Limit alcohol intake Pneumonia and flu vaccines Weight loss to BMI < 30 Exercise as tolerate |
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Heart Failure and Alternative Medications
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Hawthorn and CoQ10 - may have some benefit
Can use Omega-3 polyunsaturated fatty acids Contra - NSAIDs, COX-2 inhibitors, ephedra, ephedrine |
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Heart Failure Treatment
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Cornerstones --- diuretics, ACEI or ARB, and Beta blockers
Should be used in everyone w/ HF who does not have a contraindication or intolerance to their use |
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Diuretics
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Loops are most common (furosemide)
Have not been shown to alter the survival of HF patients, so use lowest effect dose |
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ACEIs and ARBs
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Used to reduce morbidity and mortality
Indicated for all HF patients regardless of symptoms/class |
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Beta blockers
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Metoprolol succinate, bisoprolol, carvedilol
Reduce morbidity and mortality Recommended for all HR patients, esp. class II-IV AVOID beta blockers w/ ISA |
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Aldosterone receptor antagonists
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Spironolactone, eplerenone
Reduce morbidity and mortality Added on to standard therapy in patients w/ class III or IV heart failure |
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Hydralazine/Isosorbide dinitrate
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BiDil
20/37.5 mg tablets 1 tablet TID, then 2 tablets TID as tolerated |
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BiDil info
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Direct arterial vasodilator which reduces afterload
Indicated in African-American patients w/ class III or IV heart failure Contra - PDE-5 inhibitors SE - HA, dizziness, hypotension, lupus-like syndrome |
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Isosorbide mononitrate
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Monoket
Given QD or BID Contra - PDE-5 inhibitors SE - HA, dizziness, lightheadedness, flushing, hypotension, tachyphylaxis, syncope Needs 10-12 hour nitrate free interval |
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Digoxin Info
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Inhibits Na+/K+ ATPase pump --- positive inotropic effect, negative chronotropic effect (increased CO, decreased HR)
Improves symptoms, exercise tolerance, and quality of life; reduces hospitalizations ***DOES NOT IMPROVE SURVIVAL*** |
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Digoxin
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Lanoxin
0.125-0.25 mg QD; no loading doses in HF Therapeutic range for HF --- 0.5-0.9 ng/mL Contra - 2nd or 3rd degree heart block w/o pacemaker, Wolff-Parkinson-White syndromw w/ A fib |
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Digoxin toxicity
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N/V, loss of appetite, bradycardia
Blurred/double vision, altered color perception, greenish-yellow halos around lights/objects, abdominal pain, confusion, delirium, arrhythmia ***ANTIDOTE --- DigiFab*** Hypokalemia, hypomagnesemia, and hypercalcemia increase risk of toxicity |
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Vasodilators
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Nitroglycerin, nitroprusside, nesiritide
**Monitor BP closely** |
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Nitroglycerin
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Venous vasodilator (low doses); arterial dilator at higher doses
Preferred in ADHF w/ active MI or uncontrolled HTN; effectiveness limited after 2-3 days Contra - SBP < 90, PDE-5 inhibitors, increased intracranial pressure SE - hypotension, HA, lightheadedness, tachycardia, tachyphylaxis |
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Nitroprusside
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Nitropress
Equal arterial and venous vasodilator Protect infusion from light --- degrades to cyanide (blue-color soln) BLACK BOX - keep infusion doses < 2 mcg/kg/min d/t increased cyanide toxicity risk; can cause excessive hypotension; don't give soln undiluted Same contra and SE as nitroglycerin |
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Nesiritide
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Natrecor
Recombinant B-type natriuretic peptide Arterial and venous vasodilation Contra - persistent SBP < 100 SE - hypotension, SCr |
