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CV Unit I > Clinical Treatment of Heart Failure (complete) > Flashcards

Clinical Treatment of Heart Failure (complete) Flashcards

1
Q

What are the general goals of any therapy?

A

1) ^ QOL by improving survival
2) ^ QOL by reducing symptoms
3) Decrease financial/resource burden of disease

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2
Q

What are the HF-specific goals of therapy?

A
  • Correct underlying cause of HF (sometimes it’s not possible to reverse cause, e.g. infarcted tissue)
  • Eliminate precipitating factors (infection, anemia, Na intake)
  • Reduction of congestion (fluid optimization is a major dealio!)
  • Improve flow
  • Modulate neurohormonal activation
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3
Q

What are the major classes of medications for HF?

A

1) Diuretics
2) Vasodilators
3) Neurohormonal antagonists
4) Inotropes

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4
Q

Describe the use of diuretics

A
  • Reverse Na and fluid retention of HF
  • Classes: loop diuretics, thiazide diuretic
  • Most common HF therapy
  • Can be used chronically and acutely
  • Works at far end of F-S curve => decreases in pressure produce ∆s in SV (and CO)
  • Congestion symptoms reduced w/o major effects of blood flow
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5
Q

Describe the use of arterial vasodilators

A
  • Decreases LV afterload
  • Decreases cardiac work
  • Decreases mitral regurgitation
  • hydralazine/isosorbide dinitrate in HFrEF (added to ACEI/BB in blacks «— controversial)
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6
Q

Describe the use of venous vasodilators

A
  • Decreases preload
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7
Q

Describe the use of pulmonary arterial vasodilators

A
  • Decreases RV afterload
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8
Q

Describe the use of angiotensin converting enzyme inhibitors (ACEI)

A
  • …prils (lisinopril, enalaprin, benazepril)
  • Blocks conversion of AI to AII

Causes:

  • Direct vasodilation
  • Decreased aldosterone activation
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9
Q

What are the side effects of ACEI?

A
  • Hypotension
  • Worsening renal function
  • Hyperkalemia
  • Cough (kinin potentiation)
  • Angioedema
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10
Q

Describe the use of angiotensin receptor blockers

A
  • …sartans (valsartan, candesartan, losartan)
  • Blocks AII receptor
  • Shown to be equivalent to ACEI
  • Controversial whether ACEI + ARB provides added benefit
  • Used when pts develop cough to ACEI
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11
Q

What are the side effects of ARBs?

A
  • No cough b/c no kinin production

Similar to ACEI:

  • Hypotension
  • Worsening renal function
  • Hyperkalemia
  • Angioedema
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12
Q

Describe the use of aldosterone receptor blockers

A
  • Spironolactone, eplerenone
  • Block aldosterone action in kidney (ACEI/ARB block is incomplete)
  • Decrease Na => a diuretic
  • Antifibrotic
  • Side effects: hyperkalemia, gynecomastia (spiro only)
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13
Q

Describe the use of beta-blockers

A
  • …olols
  • Antagonizing effect of sympathetic system (NE & epinephrine)
  • Beta1 block => negative chronotrope (slows HR, less arrhythmia)
  • Alpha1 block: vasodilation
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14
Q

What are the side effects of beta-blockers?

A
  • Negative inotropy: short term loss for long-term gain
  • Fluid retention, hypotension, decreased CO (cardiogenic shock)
  • Bronchoconstriction
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15
Q

Describe the use of positive inotropic agents

A
  • Used in acute situations via IV => reverse shock
  • Chronic use => worsen remodeling & ^ mortality
  • 3 types: digoxin, dobutamine, milrinone
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16
Q

Describe implanted cardioverter defibrillators

A
  • For pts with LVEF ≤ 35% or prior dangerous heart rhythms

- Abort sudden cardiac death from ventricular tachy/ fibrillation

17
Q

Describe cardiac resynchronization therapy/biventricular pacemakers

A
  • LV lead placed from RA through coronary sinus over epicardium of the LV
  • For pts w/ QRS >120 msec
  • Causes the lateral wall and septal wall to contract together
  • Produces more efficient contraction => ^ SV
  • May improve mitral valve function => decreased regurgitation
  • usually placed with ICD
18
Q

Describe Stage A therapy goals

A

Stage A: at high risk for HF but w/o structural heart disease or symptoms of HF

Goals:

  • treat HTN
  • smoking cessation
  • treat lipid disorders
  • regular exercise
  • discourage alcohol, illicit drug use
  • control metabolic syndrome
19
Q

What are the drugs used in Stage A?

A

ACEI or ARB

20
Q

Describe Stage B therapy goals

A

Stage B: structural heart disease but w/o signs/symptoms of HF

Goals:
- same as Stage A

21
Q

What are the drugs used in Stage B?

A
  • ACEI or ARB

- Beta-blockers

22
Q

What are devices used in Stage B?

A

implantable defibrillators

  • in select pts
23
Q

Describe Stage C therapy goals

A

Stage C: structural heart disease with prior or current symptoms of HF

Goals:

  • same as A & B
  • Dietary salt restriction
24
Q

What are drugs used in Stage C?

A

Routine:

  • Diuretics
  • ACEI
  • BB

Select pts:

  • Aldosterone antagonist
  • ARBs
  • Digitalis
  • Hydralazine/nitrates
25
Q

What are devices used in Stage C?

A
  • Biventricular pacing
  • Implantable defibrillators

in select pts

26
Q

Describe Stage D therapy goals

A

Stage D: refractory HF requiring specialized interventions

Goals:
- Same as A, B, & C

27
Q

What are other options in treating Stage D HF?

A
  • hospice
  • Extraordinary measures (e.g. heart transplant, chronic inotropes, permanent mechanical support, experimental surgery/drugs)
28
Q

What types of txs are used for pts with HF and normal EF?

A
  • Diuretics (volume control)
  • Treat underlying condition
  • Vasodilators => maintain normal BP
29
Q

Which treatments have not been successful in improving health outcomes for pts w/ HF and normal EF?

A
  • Neurohormonal agonists (e.g. ACEI, ARB)
  • Spironolactone
  • ICD/CRT not indicated for pts w/ >35-40%
30
Q

Describe the importance of prevention of HF. What are specific prevention goals?

A

Those w/ most conditions below can have HF prevented w/ changes in diet and lifestyle

  • HTN
  • Diabetes
  • Hyperlipidemia
  • Physical inactivity
  • Excessive alcohol intake
  • High dietary Na intake

CV Unit I (30 decks)

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