Pharmacological Management of CHF

Question 1

What are the principles of drug management for patients with heart failure?

Answer 1

1. Increase the contractility or pumping ability of the heart to relieve congestion
2. Decrease the workload on the heart by either:
   - Reducing total volume of fluid in the system (preload)
   - Reducing the vascular resistance (afterload)

Question 2

What is Digoxin and its use in HF?

Answer 2

Positive Inotropic Drug: Increases contractility of the heart; lowers HR

Di-Toxin, she is Crack

Question 3

Why are Diuretics used? And are Diuretics kept at the same dosage or does it change?

Answer 3

Decrease preload, decreasing Left Ventricular End Diastolic Volume (LVEDV)

• Patients on a “sliding scale” and dosage changes depending on amount of fluid weight gain/loss

Question 4

What are ACE inhibitors or Angiotensin Receptor Blockers used for? i.e how does this affect preload and afterload?

Answer 4

Afterload Reducers, block the effects of the renin-angiotensin system.

Blocks vasoconstriction through angiotensin II suppression, (afterload reduced).

Blocks water and salt retention via aldosterone suppression, (preload is decreased).

Question 5

Effects of Beta Blockers on
HR:
BP:
ECG:
Exercise Capacity:

Answer 5

Effects of Beta Blockers on
HR: Decrease
BP: Decrease
ECG: Decrease HR and Ischemia
Exercise Capacity: Increases with patients with angina

Question 6

Effects of Nitrates on
HR:
BP:
ECG:
Exercise Capacity:

Answer 6

Effects of Nitrates on
HR: Increase
BP: Decrease!
ECG: Increase HR and Decrease Ischemia (E)
Exercise Capacity: Increases with patients with angina, no change with CHF

(R) = Rest (E) = Exercise

Question 7

Effects of Calcium Channel Blockers on
HR:
BP:
ECG:
Exercise Capacity:

Answer 7

Effects of Calcium Channel Blockers on
HR: Decrease
BP: Decrease
ECG: Decrease HR and Decrease Ischemia (E)
Exercise Capacity: Increases with patients with angina

(Same Effects as Beta-Blockers)

Question 8

Effects of Digitalis on
HR:
BP:
ECG:
Exercise Capacity:

Answer 8

Effects of Digitalis on
HR: Decrease in patients with A-Fib
BP: No Change
ECG: ST Segment Depression (E)
Exercise Capacity: Improved only with patients with A-Fib or CHF

Question 9

Effects of Diuretics on
HR:
BP:
ECG:
Exercise Capacity:

Answer 9

Effects of Diuretics on
HR: No change
BP: No change or Decrease
ECG: May cause PVCs and “false-positive” results if hypokalemia occurs,
PVCs with hypomagnesemia
Exercise Capacity: No Change

Question 10

Effects of Vasodilators, Ace inhibitor and angiotensin II Blockers on
HR:
BP:
ECG:
Exercise Capacity:

Answer 10

Effects of Vasodilators, Ace inhibitor and angiotensin II Blockers on
HR: Increase
BP: Decrease
ECG: Increase HR or Stay the same
Exercise Capacity: Increase or Stay the same with CHF

Question 11

Effects of Nicotine on
HR:
BP:
ECG:
Exercise Capacity:

Answer 11

Effects of Nicotine on
HR: Increases
BP: Increases
ECG: Increases HR, provoke ischemia, arrhythmias
Exercise Capacity: Decreases or stays the same in patients with angina.

Question 12

Patients who are on Diuretics what are possible effects to ECG’s with hypomagnesemia?

Answer 12

Presents of PVCs