Pharm 530

Front 1

NYHA Heart Failure Classification: CLASS 1

Back 1

Patients with cardiac disease, w/o resulting limitations of physical activity. Ordinary physical activity does not cause undue fatigue, palpitations, dyspnea or angina

Front 2

NYHA Heart Failure Classification: CLASS 2

Back 2

Patients with cardiac disease, w/slight limitations of physical activity. Patients are comfortable at rest, but ordinary physical activity results in fatigue, palpitations, dyspnea or angina

Front 3

NYHA Heart Failure Classification: CLASS 3

Back 3

Patients with cardiac disease, w/limitations of physical activity. Patients are comfortable at rest, but less than ordinary physical activity results in fatigue, palpitation, dyspnea or angina

Front 4

NYHA Heart Failure Classification: CLASS 4

Back 4

Patients with cardiac disease, w/inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of angina may be present at rest. If any physical activity is undertaken, discomfort is increased.

Front 5

Treatment of Chronic HF

Back 5

Vasodilators (ACEI’s, ARB’s, Nitrates, Hydralazine, Alpha-1 Blockers)
Diuretics
K+ Sparing Diuretics
Digoxin
BB’s
CCB’s—DHP’s
Antiarrhythmics
Anticoagulants

Front 6

ACEI’s & ARB’s

Back 6

ACEI’s recommended for use in all HF patients unless contraindicated
CoughTry ARB
Angioedema
Hyperkalemia (K+ > 5.5)
Renal artery stenosis
Pregnancy
SBP <90
ARB’s alternative when ACEI’s not tolerated (except angioedema)

Front 7

Nitrates & Hydralazine

Back 7

Reserved as second line & for LVSD or if unable to take ACEI/ARB
Many ADE’s

Front 8

Diuretics

Back 8

DOC for symptomatic relief of HF
Reduce preload
Reserved more for NYHA Class II –IV (classes more likely to retain Na)
Thiazides
Good for HTN, weak diuretics
Most patients will require strength of loops
Loops
Better diuresis agents
Efficacious when CrCl <30 mL/min
First line if significant edema present
K+ supplementation Decrease arrhythmias & digoxin toxicity risk

Front 9

Potassium-Sparing Diuretics

Back 9

Alternative to K+ supplements
Weak diuretics
Monitor K+ closely
Increased caution if using w/ACEIHyperkalemia
Spironolactone—DOC in K+ sparing class

Front 10

BB’s (beta blockers)

Back 10

Can worsen HF initially (reduce CO), but then benefits seen
Blocks sympathetic stimulation
Reduction in norepi blood concentrations
Antiarrhythmic effects
Should only be initiated in stable patients already on ACEI’s & diuretics at optimized doses
Reserved for Class II-III if no contraindications

Front 11

Carvedilol (Coreg)

Back 11

FDA-approved for Class II-III HF
Recommended once on optimally-dosed ACEI & diuretic tx and only when stable

Front 12

BB’s & Carvedilol—Contraindications

Back 12

NYHA Class IV
2nd & 3rd degree heart block
Asthma/COPD
Bradycardia (HR <55)
Hypotension

Front 13

CCB’s—DHP’s

Back 13

Amlodipine (Norvasc) studied in HF
Appears to be safe in HF tx
Place in therapy—addition to ACEI & diuretic tx if patient has uncontrolled HTN or angina

Front 14

Antiarrhythmics

Back 14

Will cover in 6/30 lecture on Arrhythmias & Venous Thromboembolism

Front 15

Digoxin

Back 15

Can be used for rate control in HF w/A fib
Not absolute indication, but can be added to ACEI & diuretic therapy