Flashcards in 38 - Heart Failure Deck (41):
What defines HFrEF?
LVEF < 40%
symptoms of heart failure
dyspnea, fatigue, fluid retention
-management concomitant disease states
-moderate physical activity in stable patients
-no more than 1 alcoholic drink/day
-restrict sodium intake
-restrict fluid intake
-annual flu vaccine
-monitor daily weight
Who are ICDs for? (implantable cardioverter defibrillators)
for those with NYHA class 2-3 and LVEF < 35% or NYHA class 1 & LVEF < 30%
Who are CRTs for? (cardiac resynchronization therapy)
for those with NYHA class 2-4 despite optimal medication therapy
When using LVADs (left ventricular assist devices) use ____ bridge to transplantation
When do you use CPAP (continuous positive airway pressure) ?
for those with obstructive sleep apnea
Patients with HFrEF need long-term tx with ____ and ___
ACEi and BB
What class of drug may be preferred to an ACEi in select patients with mild-mod HFrEF ?
ARNI (combined angiotensin receptor/neprilysin inhibitor) such as valsartan/sacubitril
You can add _____ if patients are still symptomatic despite ACEi and BBs.
MRAs (mineral receptor antagonists) such as spironolactone or eplerenone
____ can control symptoms of hypervolemia
Recommend ____ for all patients. Start at low doses and titrate at 7-14 day intervals.
What do you need to monitor with ACEi?
SCr, K+ and BP before starting and changing doses.
When you start an ACEi, an increase of SCr up to ___% is expected and acceptable
In the ARNI combo valsartan/sacubitril, how does sacubitril affect valsartan?
it increases the bioavailability of valsartan
If switching between ACEi/ARNI how long do you need to wait and why?
Must wait 36 hours between ACEi and ARNI (and vice versa) to decrease risk of angioedema
How often do you titrate dose of ARNI's?
every 2-4 weeks
Which BBs are indicated for heart failure?
bisoprolol, carvedilol, metoprolol succinate (not in Canada)
points about BBs?
-start at low dose
-titrate every 2-4 weeks
-monitor BP and HR
-BBs should not be stopped abruptly
Thiazide diuretics for ____ fluid retention
____ diuretics (ex. furosemide) are required in most patients
Need to ____ doses of furosemide for patients with renal dysfunction
Thiazide diuretics have poor efficacy if CrCl < ____
Monitor what while on diuretics?
SCr and electrolytes
What do thiazide and loop diuretics deplete?
K+ and Mg2+
What to keep K+ > _____ while on diuretics?
What can you add to help with hypokalemia and hypomagnesemia?
potassium-sparing diuretics (eplerenone or spironolactone)
ARBs are an alternative to ACEi if ____ or _____ present
cough or angioedema
What are MRAs for?
for patients who remain symptomatic despite use of ACEi and BB.
Do not use MRAs if ???
K+ > 5 mmol/L, sCr > 221 umol/L or CrCl < 30
Which MRA (spironolactone or eplerenone) can cause gynecomastia?
Who is ivabradine used for?
for those with LVEF < 35% who present with NHYA class 2-3 symptoms, resting HR > 77 despite using BBs or if they cant use BBs
*Target HR 50-60 bpm
____ can help improve HF symptoms
When should you check digoxin levels and what is the target?
Check digoxin serum levels at least 8 hours after drug administration (target 0.6 - 1 nmol/L)
Who is ISDN/hydralazine for?
black patients or those who can't tolerate other options
*nitrates alone do not reduce mortality
Can use omega 3 FAs but high doses > 3g/day increases risk for ___
Which CCB is safe?
amlodipine is safe but does not decrease mortality/morbidity
Which anti-arrhythmic can be used to maintain sinus rhythm if they also have A. Fib?
Reasonable to also consider ____ as add on for cardioprotection
How do we manage this?
-focus tx on control of risk factors
-consider ACEi or ARB for HRN, esp if DM
-should use MRA.
-Can use BB or diuretics if indicated
-can use verapamil or diltiazem