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35 Cards in this Set
- Front
- Back
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Systolic heart failure is characterized by what?
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Impaired contractility
Ejection fraction < 40% Preserved filling |
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Diastolic heart failure is characterized by what?
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Impaired filling
Normal ejection fraction Preserved contractility |
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NYHA Class I heart failure means what?
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Daily activities not affected by symptoms
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NYHA Class II heart failure means what?
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Ordinary physical activity results in symptoms of fatigue, dyspnea
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NYHA Class III heart failure means what?
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Less than ordinary activity results in symptoms of fatigue, dyspnea
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NYHA Class IV heart failure means what?
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Heart failure symptoms present at rest
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ACC/AHA stage A means what?
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High risk of developing heart failure
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ACC/AHA stage B means what?
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Structural heart disease, asymptomatic
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ACC/AHA stage C means what?
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Current or prior HF
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ACC/AHA stage D means what?
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Advanced structural disease, symptomatic at rest
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Preload means what?
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The amount of blood coming back to the heart that has to be pumped out
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Afterload means what?
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The work that the heart has to generate to pump blood forward
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What is left ventricular remodeling?
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A change in LV geometry, mass and volume that occurs over a period of time
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What drugs are used to limit LV remodeling?
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ACEIs
ARBs |
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What are the effects of endothelin?
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Vasoconstrictor
Worsens hemodynamic compromise Decreases cardiac output |
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What are the effects of arginine vasopressin?
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Stimulate V1 receptors on vasculature (vasoconstriction)
Stimulate V2 receptors in the kidneys (Promotes free H2O absorption, hyponatremia) |
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What do V2 antagonists do?
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Promote aquaresis without sodium depletion
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What peptide is released by the LV in response to increased wall tension?
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BNP (brain natriuretic peptide)
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What patients receive ACE inhibitors unless contradicted?
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All patients with LV dysfunction
All patients with history of MI regardless of EF |
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What drugs can you use if a patient cannot tolerate ACEI/ARBs?
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Hydralazine
Nitrates |
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What is the MOA of hydralazine?
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Arterial vasodilator
Decrease afterload/blood pressure |
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What is the MOA of nitrates?
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Venous dilators (decrease preload)
Relax blood vessels |
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BiDil is a combination of what drugs?
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Hydralazine
Isosorbide dinitrate |
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Bisoprolol can be used for what class of CHF?
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III
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For a patient who needs an aldosterone antagonist, what should their serum potassium and creatinine be?
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Potassium: < 5 mEq/L
Creatinine: < 2.5 mg/dL |
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What is the MOA of digoxin?
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Reduced sympathetic outflow from CNS
Increases contractility, slows conduction through AV node |
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What are the toxicities of digoxin?
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GI
CNS Conduction |
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What is the definition of diastolic dysfunction?
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EF > 55%
Impaired ventricular relaxation and filling |
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What are the drugs to accomplish afterload reduction in diastolic dysfunction?
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ACEI
ARB |
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What drugs reduce preload in diastolic dysfunction?
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Diuretics
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What drugs decrease heart rate in diastolic dysfunction?
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Beta blockers
CCBs (diltiazem, verapamil) |
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What drugs should be avoided in heart failure?
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NSAIDs
COX-2 inhibitors Corticosteroids Most antiarrhythmics Most CCBs |
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What are the therapies for stage A HF?
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Lisinopril daily
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What are the therapies for stage B HF?
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Lisinopril daily
Carvedilol BID |
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What are the therapies for stage C/D HF?
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Lisinopril, Carvedilol
Spironolactone Consider diuretics/digoxin |
