ch 42 Flashcards
(52 cards)
which heart failure is referred to as heart failure with reduced ejection fraction (HFrEF)
HF with L ventricular (LV) systolic dysfunction
which heart failure is referred to as heart failure with preserved LV ejection fraction (HFpEF)
Diastolic HF
drug classes for HF
diuretics
inhibitors of RAAS
B Blockers Digoxin
what does the heart do to compensate in HF
1) Cardiac dilation
2) activation of SNS
3) Activation of RAAS
4) Retention of water and expansion of blood volume
extra info below
Dilation of the heart from a combo of increased venous pressure and reduced contractile force
Size of heart increases to help improve cardiac output
Arterial pressures fall, the baroreceptor reflex increases sympathetic output to heart, veins and arterioles
Increased heart rate
increased contractility
increased venous tone
increased arteriolar tone
body starts to retain water to improve pressure. leads to severe cardiac, pulmonary and peripheral edema and eventually death
what natriuretic peptides are released in response to the stretching of the atria and dilation of the ventricles
ANP and BNP
level of BNP is an important index of
cardiac status in HF patients and can be a predictor of long term survival
As HF progresses, the effects of ANP and BNP eventually become overwhelmed by the effects of the
SNS and RAAS
signs of HF
reduced exercise tolerance fatigue Shortness of breath tachycardia cardiomegaly pulmonary edema peripheral edema hepatomegaly distention of jugular veins weight gain
what NYHA scheme heart failure class is
no limitation of ordinary physical activity
Class I
what NYHA scheme heart failure class is
slight limitation of physical activity: normal activity produces fatigue, dyspnea, palpitations, angina
Class II
what NYHA scheme heart failure class is
Marked limitation of physical activity: even mild activity produces symptoms
Class III
what NYHA scheme heart failure class is
Symptoms occur at rest
Class IV
ACCAHA scheme stage:
at high risk for HF but without structural heart disease or symptoms of HF
Stage A
ACCAHA scheme stage:
structural heart disease but without symptoms of HF
Stage B
ACCAHA scheme stage:
Structural heart disease with prior or current symptoms of HF
Stage C
ACCAHA scheme stage:
refractory HF requiring specialized intervention
Stage D
first line drugs for all patients with signs of volume overload (HF)
diuretics
diuretic used for long term therapy of HF when edema is not too great. But low GFR excludes this drug
Thiazide diuretics
diuretic needed for HF requiring profound diuresis. This will work even with low GFR
Loop diuretics
this class of diuretic is usually combined with either a thiazide or loop to preserve potassium. prolongs survival in pt with HF by blocking receptors for aldosterone
Potassium sparing
particularly Spironolactone
this antihypertensive can improve functional status and prolong life in HF. Blocks production of angiotensin II which decreases release of aldosterone. suppresses degradation of kinins which improves hemodynamics and favorably alters cardiac remodeling
ACE inhibitors (Captopril, enalapril)
ACE inhibitors with potassium sodium and water and what does that do
inhibits aldosterone secretion from adrenal cortex that acts on the renal tubules to excrete sodium which works on water and decreases fluid volume. This also means that they retain potassium making risk for hyper -k
what part of ACE helps with cardiac remodaling
decrease kinin degradation and decrease release of aldosterone
adverse effects of ACE
hyperkalemia (secondary to aldosterone release)
intractable cough and angioedema (secondary to decrease kinin degradation), renal fauilure in patients with bilat renal artery stenosis.
