CHF Flashcards
1
Q
What is Stage A in CHF
A
High risk of HF
2
Q
What is Stage B in CHF
A
ASx HF
3
Q
What is Stage C in CHF
A
Symptomatic HF
4
Q
What is Stage D in CHF
A
Refractory end-stage HF
5
Q
What do you give in Stage A
A
ACEI
ARBs
6
Q
What do you give in Stage B
A
ACEIs/ARBs or Beta blockers
7
Q
What do you give in Stage C
A
AceIs/ARBs AND Beta blockers
8
Q
What do you give in Stage D
A
End of life care
Extraordinary measures
9
Q
Most common cause of HF in USA
A
CAD and HTN
10
Q
Sx in HF
A
Decreased exercise tolerance
Dyspnea
Peripheral/pulm edema
Cardiomegaly
11
Q
What is seen in Systolic failure
A
Reduced contractility and EF
12
Q
What is seen in Diastolic failure
A
Stiffening (less relaxation)
Reduced CO, but normal EF
13
Q
What is seen in CHF
A
Abnormal BV and IF fluid increase
Dyspnea
Peripheral edema
14
Q
Physiological compensation in CHF
A
Activation of SNS, RAAS
Tissue remodelling
15
Q
4 Factors affecting cardiac performance
A
Preload
Afterload
Contractility
HR
16
Q
What is preload
A
Stretching of myocardial muscles to increase contractility
17
Q
What is afterload
A
Force against which the ventricles act
18
Q
What is contractility directly related to
A
Ca concentration
19
Q
Drugs for systolic failure
A
Diuretics Spironolactone ACEIs ARBs Direct vasodilators Beta blocers Inotropic agents
20
Q
Drugs for diastolic failure
A
Diuretics
Ca channel blockers
Beta blockers
21
Q
What do you never give in diastolic failure
A
+ve Inotropic agents
22
Q
DOC in heart failure
A
ACEIs
23
Q
Teratogenic so contraindicated in pregnancy
A
ACEIs
ARBs
24
Q
Reduce HF Sx and Hospital time
A
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
```
