Flashcards in Chronic HF Deck (45):
inability to provide enough oxygenated blood to the rest of the body
Risk factors for chronic heart failure
Presentation of chronic heart failure
Describe systolic heart failure
-problem with ejection of blood to the lungs or systemic circulation
-result of hypertrophy and dilation of ventricle
-EF less than 40
Describe diastolic heart failure
-inability of the heart to fill appropriately
-results from stiffness of the myocardium
-more difficult to treat
What is MC systolic or diastolic heart failure?
What class is more effective in HF?
Beta blockers to treat heart failure?
blockage of beta receptors lead to decrease heart rate, decrease BP, increase coronary artery blood flow
BB indications (stages)
Can be used in stages A and B
Should be used in stage C
worse HF if dose is too high
ACE I/ARB names
ACE I/ARBS MOA
interference with RAAS ending with disrupting angiostensin II, produce decrease BP, Sodium/H2O retention, after load reducer
ACE I/ARBS indications
all stages of HF
goal dose is needed to max mortality/morbidity benefit
What meds are used in ALL stages of heart failure?
ADE ACE I/ARBsCI
ADE: hyperkalemia, cough, hypotension
CI: prego, hyperkalemia-K greater than 5.0, bilateral renal artery stenosis, angioedema
ACE I/ARBs excreted in the:
compete w/aldosterone for intracellular mineralcortocoid receptor causing Na/H2O to excrete which decreases preload
Aldosterone blockers in indicated for which stages of HF?
C and D HF
ADE aldosterone blockers
Are aldosterone blockers protein bound?Where are they excreted?
direct arterial vasodilator- coronary, cerebral and renal arteries
HA (hydralzaine arterial)
Isosorbide dinitrate MOA
direct venodilator - convert into NO for vasodilation
Vasodilators are indicated for what patients?
African American pts with stage C HF (along w/ ACE, BB etc)
used in B/C/D HF
Not CI to ACE I
ADE of vasodilators
Tolerance to nitrates
CI: not really excreted
Are vasodilators dosed multiple times a day?
Yes so they have bad compliance
What are the Loop Diuretics?
Whats the MOA of Loops?
Exert action at loop of henle
increases Na + H2O excreted
reduces preload and edema
What is the indication of Loops?
Initial: Sx HF (C or D)
goal: after diuresis + fluid reduction, get pt to lowest dose possible or consider d/c
electrolytes- hypokalemia, hypomagnesemia, hyperglycemia, hyperuricemia
Do pts with renal failure need higher or lower doses of Loops?
increase inotropic activity and decrease chronotropic activity
increase intracellular Na + Ca which increases force of contraction
low dose for normal renal fxn
only in Sx HF stage C/D
elderly/renal insufficient- dose every other day!
Toxicity- monitor it!
electrolytes- hypokalemia, hypomagnesemia
Why do the elderly/renal insufficient have a lower dose of digoxin?
a large VD
large in obese/small in elderly and primarily renally excreted
Drugs to use for Morbidity?
digoxin and diuretics
How does potassium effect digoxin?
hypoK increases effects
hyperK decreases effects
What are the 4 compensatory mechanism of HF
Frank Starlings Law of the heart
What blocks the RAAS
ACE-I ARBs Aldosterone blockers
What blocks the SNS
What blocks ventricle hypertrophy
BB ACE-I ARBs Aldosterones
What Blocks the Frank Starling Law
Hx of HF because there is a natural temporary fixing of first event HF (NO hx MI)