38 - Heart Failure Flashcards Preview

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Flashcards in 38 - Heart Failure Deck (41):
1

What defines HFrEF?

LVEF < 40%

2

symptoms of heart failure

dyspnea, fatigue, fluid retention

3

non-pharms

-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
-pneumococcal vaccine
-monitor daily weight

4

Who are ICDs for? (implantable cardioverter defibrillators)

for those with NYHA class 2-3 and LVEF < 35% or NYHA class 1 & LVEF < 30%

5

Who are CRTs for? (cardiac resynchronization therapy)

for those with NYHA class 2-4 despite optimal medication therapy

6

When using LVADs (left ventricular assist devices) use ____ bridge to transplantation

ASA

7

When do you use CPAP (continuous positive airway pressure) ?

for those with obstructive sleep apnea

8

Patients with HFrEF need long-term tx with ____ and ___

ACEi and BB

9

HFrEF:
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

10

HFrEF:
You can add _____ if patients are still symptomatic despite ACEi and BBs.

MRAs (mineral receptor antagonists) such as spironolactone or eplerenone

11

HFrEF:
____ can control symptoms of hypervolemia

diuretics

12

HFrEF:
Recommend ____ for all patients. Start at low doses and titrate at 7-14 day intervals.

ACEi

13

HFrEF:
What do you need to monitor with ACEi?

SCr, K+ and BP before starting and changing doses.

14

HFrEF:
When you start an ACEi, an increase of SCr up to ___% is expected and acceptable

30%

15

HFrEF:
In the ARNI combo valsartan/sacubitril, how does sacubitril affect valsartan?

it increases the bioavailability of valsartan

16

HFrEF:
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

17

HFrEF:
How often do you titrate dose of ARNI's?

every 2-4 weeks

18

HFrEF:
Which BBs are indicated for heart failure?

bisoprolol, carvedilol, metoprolol succinate (not in Canada)

19

HFrEF:
points about BBs?

-start at low dose
-titrate every 2-4 weeks
-monitor BP and HR
-BBs should not be stopped abruptly

20

HFrEF:
Thiazide diuretics for ____ fluid retention

fluid

21

HFrEF:
____ diuretics (ex. furosemide) are required in most patients

loop

22

HFrEF:
Need to ____ doses of furosemide for patients with renal dysfunction

increase

23

HFrEF:
Thiazide diuretics have poor efficacy if CrCl < ____

50 mL/min

24

HFrEF:
Monitor what while on diuretics?

SCr and electrolytes

25

HFrEF:
What do thiazide and loop diuretics deplete?

K+ and Mg2+

26

HFrEF:
What to keep K+ > _____ while on diuretics?

4 mmol/L

27

HFrEF:
What can you add to help with hypokalemia and hypomagnesemia?

potassium-sparing diuretics (eplerenone or spironolactone)

28

HFrEF:
ARBs are an alternative to ACEi if ____ or _____ present

cough or angioedema

29

HFrEF:
What are MRAs for?

for patients who remain symptomatic despite use of ACEi and BB.

30

HFrEF:
Do not use MRAs if ???

K+ > 5 mmol/L, sCr > 221 umol/L or CrCl < 30

31

HFrEF:
Which MRA (spironolactone or eplerenone) can cause gynecomastia?

spironolactone

32

HFrEF:
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

33

HFrEF:
____ can help improve HF symptoms

digoxin

34

HFrEF:
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)

35

HFrEF:
Who is ISDN/hydralazine for?

black patients or those who can't tolerate other options

*nitrates alone do not reduce mortality

36

HFrEF:
Can use omega 3 FAs but high doses > 3g/day increases risk for ___

bleeds

37

HFrEF:
Which CCB is safe?

amlodipine is safe but does not decrease mortality/morbidity

38

HFrEF:
Which anti-arrhythmic can be used to maintain sinus rhythm if they also have A. Fib?

amiodarone

39

HFrEF:
Reasonable to also consider ____ as add on for cardioprotection

statins

40

HFpEF:
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

41

How do you handle decompensated HF ?

-furosemide
-can add a vasodilator such as nitroglycerin
-for low cardiac output, add milrinone or dobutamine if systolic > 90
*dobutamine is preferred if systolic < 90
-limit use of vasopressors (dopamine or NE)
-may have short-term vasopressin antagonist Tolvaptan

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