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27 Cards in this Set
- Front
- Back
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What is stage a heart failure |
At risk for development of failure, patients with high blood pressure, diabetes, coronary heart disease, use of cardiotoxic medication, or family history of cardiomyopathy but without symptoms |
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What is stage B of heart failure |
Patients with structural heart diseas post MI, valvular disease, LVSD that is a symptomatic |
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What is stage C of heart failure |
Known structural disease or with previous symptoms |
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What is stage D of heart failure |
Refractory heart failure with specialized interventions |
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How do you treat systolic heart failure |
Determine cause and precipitating factors, nonpharmacologic interventions include cardiac rehab and restriction of fluids and sodium |
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What are pharmacological interventions for stage a systolic heart failure |
ACE inhibitors or ARB |
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What is pharmacological treatment for stage B of systolic heart failure |
Ace or ARB + beta blocker |
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What is pharmacological treatment for stage C of systolic heart failure |
Diuretic, Ace or aRB, beta blocker, if symptoms do not improve aldosterone receptor antagonist, ARB, digoxin, hydralazine or imdur |
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What is treatment for stage D of systolic heart failure |
Consider specialized interventions such as mechanical circulatory support, continuous inotropic therapy, cardiac transplant, Hospice Care, this is beyond the office |
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What types of diuretics are used for heart failure |
Hydrochlorothiazide is rarely used as monotherapy, metazolone may be used with a loop diuretic to promote diuresis, loop diuretics may be necessary to maintain euvolemia |
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How do ACE inhibitors help systolic heart failure |
Reduce ventricular remodeling, myocardial fibrosis, myocyte apoptosis, cardiac hypertrophy, norepinephrine release, vasoconstriction, and sodium and water retention |
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When are ace inhibitors used in heart failure |
To improve symptoms and slow disease progression and decrease mortality in patients with Stage c failure, used to prevent development of heart failure and stages A&B |
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Why are beta blockers used for heart failure |
To slow disease progression, decrease hospitalizations and reduce mortality |
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How do beta blockers help with heart failure |
Anti-arrhythmic effects, slow or reverse ventricular remodeling, decrease myocyte death from catecholamine induced necrosis, improve left ventricular systolic function, decrease heart rates and ventricular wall stress thereby reducing myocardial oxygen demand, inhibiting plasma renin release |
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When are beta blockers recommended in heart failure patients |
In all stable patients with heart failure and left ventricular ejection fraction decrease |
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What are the only beta blockers shown to reduce mortality in large heart failure trials |
Carvedilol, metoprolol, bisprolol |
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How should you dose beta blockers in heart failure |
Doses should be doubled no more than every two weeks to maximally tolerated dose |
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How do angiotensin 2 receptor blockers work for heart failure |
Cause vasodilation and decreased ventricular remodeling, used for patients intolerant to ACE inhibitors, start low and go slow, may be considered in patients who are symptomatic with diuretic, ace, beta blocker |
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What should you monitor when giving angiotensin 2 receptor blockers to heart failure patients |
Blood pressure, renal function, potassium, used with caution in patients with Ace induced angioedema |
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How do aldosterone antagonist work for heart failure and what do you need to monitor |
Spironolactone and eplerenone block mineral corticoid receptors and attenuate cardiac fibrosis and ventricular remodeling, reduced pro inflammatory state and oxidative stress caused by aldosterone, reduce mortality in trials of patients with moderate to severe heart failure, monitor potassium |
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How does digoxin help with heart failure |
Benefits are neurohormonal, attenuate excessive sympathetic nervous system activation present in heart failure, decreases heart rate, controls ventricular response rate in patients with atrial fib and svt |
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How do nitrates and hydralazine work for heart failure |
Have complimentary hemodynamics persons, nitrates are vasodilator and hydralazine is a direct vasodilator that acts on arterial smooth muscle, side effects are headache dizziness GI distress |
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What are treatments for ischemic heart disease |
Risk factor modification, beta blockers, nitrates, calcium channel blockers, ranolazine |
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What percent do beta blockers improve symptoms in patients with chronic stable exertional angina |
80% |
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How are nitrates used for ischemic heart disease |
Used to terminate acute angina attack to prevent effort or stress induced angina or for long-term prophylaxis, usually in combination with beta blockers, calcium channel blockers, sublingual nitroglycerin |
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How are calcium channel blockers used for ischemic heart disease |
Use in Prinzmetal angina, peripheral vascular disease, severe ventricular dysfunction, concurrent hypertension, amlodipine beta blocker of choice in severe ventricular dysfunction |
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How does ranolazine work in ischemic heart disease |
Reduces calcium overload in ischemic myocytes through inhibition of late sodium current, indicated in treatment of chronic angina, does not affect heart rates, prolongs QT interval |
