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Flashcards in CHF Deck (89):
1

What is Stage A in CHF

High risk of HF

2

What is Stage B in CHF

ASx HF

3

What is Stage C in CHF

Symptomatic HF

4

What is Stage D in CHF

Refractory end-stage HF

5

What do you give in Stage A

ACEI
ARBs

6

What do you give in Stage B

ACEIs/ARBs or Beta blockers

7

What do you give in Stage C

AceIs/ARBs AND Beta blockers

8

What do you give in Stage D

End of life care
Extraordinary measures

9

Most common cause of HF in USA

CAD and HTN

10

Sx in HF

Decreased exercise tolerance
Dyspnea
Peripheral/pulm edema
Cardiomegaly

11

What is seen in Systolic failure

Reduced contractility and EF

12

What is seen in Diastolic failure

Stiffening (less relaxation)
Reduced CO, but normal EF

13

What is seen in CHF

Abnormal BV and IF fluid increase
Dyspnea
Peripheral edema

14

Physiological compensation in CHF

Activation of SNS, RAAS
Tissue remodelling

15

4 Factors affecting cardiac performance

Preload
Afterload
Contractility
HR

16

What is preload

Stretching of myocardial muscles to increase contractility

17

What is afterload

Force against which the ventricles act

18

What is contractility directly related to

Ca concentration

19

Drugs for systolic failure

Diuretics
Spironolactone
ACEIs
ARBs
Direct vasodilators
Beta blocers
Inotropic agents

20

Drugs for diastolic failure

Diuretics
Ca channel blockers
Beta blockers

21

What do you never give in diastolic failure

+ve Inotropic agents

22

DOC in heart failure

ACEIs

23

Teratogenic so contraindicated in pregnancy

ACEIs
ARBs

24

Reduce HF Sx and Hospital time

DIgoxin

25

Increase exercise tolerance

Digoxin

26

Does NOT increase survival

Digoxin

27

What Thiazides are used in CHF

Chlorthalidon
Hydrochlorothiazide
Metolazone

28

What Loops are used in CHF

Ethacrynic acid
Furosemide
Torsemide

29

What Aldosterone antagonists are used in CHF

Spironolactone
Eplerenone

30

What ACEIs are used in CHF

Captopril
Enalapril
Lisinopril

31

What ARBs are used in CHF

Candesartan
Valsartan

32

What direct vasodilators are used in CHF

Hydralazine
NItrates (Isosorbide Dinitrate)

33

What beta blockers are used in CHF

Carvedilol
Metoprolol

34

What is the cardiac glycoside used

Digoxin

35

What are the Inotropic agents used in CHF

Digoxin
Milrinone
Inamrinone
DA
Dobutamine
Glucagon

36

Which are more effective, loops or thiazides in CHF

Loops

37

When do you give thiazide over loop in CHF

Hypertensive heart disease with congestive sx

38

How do loops and thiazides treat CHF

Relieve pulm congestion and peripheral edema
Decrease orthopnia
Decrease VR and preload and afterload

39

What do you combine aldosterone antagonists to reduce mortality and morbidity of sever HF

ACEIs

40

How do aldosterone antagonists treat CHF

Prevent Na retention, K loss and mycardial hypertrophy

41

When do you give Aldosterone antagonists

Advanced HF
LV dysfunction post MI

42

When are aldosterone antagonists contraindicated

Pts on K supplements

43

GI AE of aldosterone antagonists

Gastritis
PUD

44

Endocrine AE of aldosterone antagonists

Gynecomastia
Decreased libido
Mestrual irregularities

45

Metabolic AE of aldosterone antagonists

Hyperkalemia

46

CNS AE of aldosterone antagonists

Lethargy
Confusion

47

Which ARB is used for HTN vs CHF

HTN - Lorsartan
CHF - Candesartan

48

How do ARBs act in CHF

Block AT-I receptor
No effect on bradykinin

49

Effects of ACEIs in CHF

Decrease PVR, BP, afterload, preload, Na/H2O retention, long term remodelling
Increase CO

50

When do you give ACEIs in CHF

Symptomatic HF
Asymptomatic HF with decreased LV EF or Hx of MI

51

Which high risk groups can you give ACEIs to

Diabetes
HTN
Atherosclerosis
Obesity

52

When do you give ARBs

Intolerant to ACEIs
Cough/Angioedema

53

AE of ACEIs/ARBs

Dry cough (NOT ARBs)
Hypotension
Renal insufficiency
Hyperkalemia
Angioedema

54

What vessels does Hydralazine dilate

Arterioles

55

What vessels do nitrates dilate

Venules

56

When do you give direct vasodilators

Intolerant to ACEIs or beta blockers
Adjuvant in Black with advanced HF

57

AE of Hydralazine

Lupus-like
Tachycardia
Peripheral neuritis

58

How do beta blockers affect CHF

Reverse remodelling

59

How do beta blockers act

Decrease HR and RAAS
Protect cardiac muscle from NE

60

When do you give beta blockers in CHF

Stage B and C with ACEI

61

What can initial beta blocker tx cause

Fluid retention

62

Cautious use of beta blockers in whom

Asthma
Severe bradycardia

63

Has a narrow therapeutic window

Digoxin

64

Which CHF drug is +ve inotropic and -ve chronotropic

Digoxin

65

When is Digoxin indicated

HF with A-fib
Give with ACEI and beta blocker

66

How does Digoxin act

Inhibit Na/K ATPase
Indirect Na/Ca exchange inhibition
Increase Ca
Increase contractility

67

Effect of Digoxin on HR

Reduces via decreased SNS, RAAS, PVR

68

How does Digoxin increase refractory period

Decrease conduction through AV node

69

Where does Digoxin accumulate

Muscle (high Vd)

70

Does Digoxin need a loading dose?

Yes

71

What can precipitate Digoxin toxicity

Hypokalemia

72

How does Digoxin cause Hypokalemia

Competes with K for binding on ATPase

73

Digoxin toxicity Sx

Atrial arrhythmias
Altered color perception
Halos on dark objects

74

How do you treat Digoxin toxicity

Withdraw/Reduce
Digitalis Abs

75

Tx for Digoxin tox with V-tach

Lidocaine and Mg or increase K

76

Contraindications of Digoxin

Diastolic/Right HF
Uncontrolled HTN
Bradyarrhythmias

77

What do you NEVER coadmin with Digoxin and why

Quinidine
Verapamil
Amiodarone
Compete with kidney excretion (Increase levels of digoxin in body)

78

PDE3 inhibitor for short term increase in CO

Milrinone
Inamrinone

79

Can increase AV conduction

Milrinone
Inamrinone

80

+ve inotropic, increase CO and decrease preload and afterload

Milrinone
Inamrinone

81

When do you give DA in CHF

Tx for shock after volume replacement

82

What is the effect of an intermediate dose of DA

Dopaminergic and beta 1 receptors
Increase force and rate of contraction and renal vasodilation

83

What is the effect of an lowdose of DA

D1 only
Dilate renal and mesenteric BVs

84

What is the effect of an high dose of DA

Alpha 1 only
Vasoconstriction (no good)

85

What is used in short term management of pts with cardiac decompensation

Dobutamine

86

How does dobutamine work

+ve inotropic, vasodilation
Increase contraction

87

What does Dobutamine not affect

HR

88

When do you give Glucagon

Acute cardiac dysfunction from beta blocker OD

89

How does glucagon work

Increase contractility (not beta)
Inotropic and chronotropic