HF

Question 1

CHF lab values

Answer 1

1. LFTs (ALT/AST) elevated –> indicative of congestive hepatopathy
2. Elevated troponin
3. elevated BNP (brain natriuretic peptide)
4. ECHO
5. Imaging: MRI, EKG, Chest Xray
6. CBC
7. urinalysis
8. serum Ca and Mg
9. serum Cr
10. glucose
11. Lipids (LDL, HDL)
12. thyroid functioning hormone

Question 2

CHF Vasodilator therapy

Answer 2

1. IF hypertensive (SBP >100) in presence of acute pulmonary edema–> NTG or nitroprusside should be considered
2. IF hypotensive (SBP<100)–> consider vasodilators (

Question 3

ADHF Low Perfusion regimen

Answer 3

• inotropes increase contractility then increase cardiac output
• Dobutamine (B1 agonist~ increase contractility and HR) & milrinone (has vasodilator properties ~ PDEIII inhibitor, increase cAMP)

Question 4

ADHF Volume Overload regimen

Answer 4

• decrease volume
• loop diuretics (furosemide, bumetanide)
• thiazide diuretics (hydrochlorothiazide, chlorothiazide)

Question 5

CHF S/SX

Answer 5

• cough, SOB, weakness, hypoxia, S3 gallop: abnormal heart sounds, low perfusion, PND, pulmonary rales, weight gain, peripheral edema, JVD, HJR, hepatomegaly

Question 6

HF Meds

Answer 6

1. ACEI/ARB
2. If not, Entresto (Sacubitril/Valsartan)
3. BB (Carvedilol or Metoprolol XR)
4. Spironolactone (aldosterone receptor antagonist)
5. Loop Diuretic: Furosemide
6. Hydralazine : add on therapy for AA who have EF <40% or symptomatic HF
7. Digoxin for HFrEF patients who need extra rate control
   
   • goal: 0.5-0.9 ng/ml

Question 7

ACEI MOA

Answer 7

prevents left ventricular remodeling
reduce formation of angiotensin II
- reduces after load and preload 
- vasodilation and improves EF
- reduced hospitalizations

Question 8

ARB MOA

Answer 8

blocks binding angiotensin II to AT1 receptors in heart, kidneys, and blood vessels

• inhibits remodeling
• preload and afterload reduction
• vasodilation and improved EF

Question 9

BB MOA

Answer 9

control HR and reduce arrhythmia

• metoprolol: blocks B1 receptors
• carvedilol: blocks B1 and 2 & alpha receptors

reduce workload of the heart by slowing down rate and reducing contractility

Question 10

Hydralazine MOA

Answer 10

release NO, increasing cGMP, relaxing SM of blood vessels

-relaxes SM of blood vessels and dilates both veins and arteries

Question 11

Spironolactone MOA

Answer 11

Aldosterone antagonist
K+ sparing diuretic
-helps keep your body from absorbing too much salt and keeps your K+ levels from getting too low

Question 12

Furosemide MOA

Answer 12

Inhibition of the Na/K/Cl transporter in the thick ascending loop of Henle

Question 13

Vitamin D MOA

Answer 13

Regulates gene transcription via the vitamin D receptor
-for osteoporosis, Vitamin D deficiency rickets, osteomalacia, psoriasis

SE= hypercalcemia, hypercalciuria, hyperphosphatemia