Congestive Heart Failure Flashcards Preview

Pharmacology > Congestive Heart Failure > Flashcards

Flashcards in Congestive Heart Failure Deck (48):
1

What is CHF?

Inability of the heart to pump enough blood to provide the O2 needed by the body, LV is not efficently pumping to meet metabolic needs

2

What is stroke volume driven by?

preload, afterload, and contractility

3

Ejection

amount of blood pumped out of heart during each beat

4

Fraction

the volume of blood expelled vs remaining volume after pumping

5

Normal EF

55-75%

6

Systolic heart failure is caused by

decrease in ventricular EF, impaired contractility, increased afterload, aortic stenosis, cardiomyopathy, mechanical abnormalities

7

Diastolic heart failure is caused by

decrease in ventricular relaxation during diastole, chronic hypertension, pulmonary hypertension

8

Mixed heart failure pts will have

low EF, high pulmonary pressures, dilated cardiomyopathy

9

Drugs that cause HF

antiarrhythmics, CCBs, chemotherapy, Na and H2O retention by steroids, NSAIDs, some diabetic drugs

10

Cardiovascular symptoms

tachycardia, cardiomegaly, dysrhythmias, fatigue, exercise intolerance

11

Repiratory symptoms

SOB, orthopnea, pulmonary edema, cyanosis

12

GI symptoms

epigastric fullness, anorexia, ascites, cardiac cachexia, hepatomegaly

13

Renal symptoms

peripheral edema, hypernatremia, hypomagnesemia, decreased urine output, hypokalemia

14

Class I

no limitation of activity, activity does not induce fatigue, dyspnea, angina

15

Class II

slight limitation of activity, no symptoms at rest, ordinary activity results in fatigue, angina, dyspnea

16

Class III

Marked limition of activity, comfortable at rest, activity causes angina, dyspnea, fatigue

17

Class IV

inability to carry on any physical activity w/o discomfort, cardiac insufficiency or angina present at rest, discomfort increased with activity

18

Stage A

Patients at high risk of developing dysfunction because of existing conditions

19

Stage B

Patients develop structural heart disease but do not show symptoms

20

Stage C

patients have current or prior symptoms associated with underlying heart disease

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Stage D

advanced structural heart disease and marked symptoms of HF at rest despite intervention, end stage disease

22

Goals of therapy

prevent disease progression, reduce morbidity/mortality, reduce hospitalizations

23

Non-pharmacological approaches

remove precipitating causes, exercise if able, Na restriction, fluid restriction, weight control

24

Focus of medical treatment

inhibit compensatory processes, ACE inhibitors, BB, aldosterone antagonists, prevent cardiac remodeling, vasodilators, diuretics, inotropic agents, Symptom control!

25

Most common treatment

Furosemide, bumetanide, LOOP diuretic, end stage will include thiazide too

26

Diuretic key points (4)

daily dose adjustment based on weight, keeps pts out of hospitals, increase dose with decrease kidney, K sparing used for activity of aldosterone

27

ACE-I key points (5)

used to prevent cardiac remodeling, use with caution with K sparing, sudden fluid changes can drop BP, NO pregnant pt, renal artery stenosis or angioedema, can cause hyperkalemia or hypotension

28

ARB key points (2)

usually used as alternative to ACE-I when not tolerated, used for SE

29

Hydralazine/isosorbide dinitrate combo

acts on artery and vein, reduces pre and afterload, hard to tolerate, limits use, African american pt use as adjunct therapy

30

BB key points (3)

improve outcome because effect NE, EPI, and angiotensin II, Metroprolol DOC, use low dose

31

Spironolactone (4)

only use 25 mg, only benefit for NYHA III or IV, also benefit post-MI, watch K+

32

Digoxin (6)

no benefit on outcome, mild positive inotropic, Never discontinue once start, decrease node conduction, only HF and Afib, TDM required

33

Digoxin toxicity presents as

anorexia, N/V/D, abdominal pain, visual disturbances, fatigue, confusion, arrhythmias, AV block, tachycardia

34

Acute decompensated heart failure

CV function becomes so impaired it requires hospital admission for aggressive treatment and monitoring

35

Cardiogenic shock

profound hypotension and low CO

36

What causes AHF

uncontrolled HTN, poor compliance, Afib, environmental factors, inadequate therapy, pulmonary infection, arrhythmias, CCB, ibuprofen, naproxen

37

Diagnosing AHF

BNP, ECHO, BP, pulmonary artery catheters, central venous pressure (2-6), MAP (80-100)

38

Warm and wet

pt has normal cardiac index, good bp, high PCWP, fluid in lungs or other lung symptoms

39

Cool and dry

poor perfusion, low crdiac index, PCWP normal, no lung symptoms

40

Cool and wet

worst case scenario, poor perfusion, lung symptoms, requires ICU admission

41

Loop diuretic treatment for AHF

use with caution, too rapid diuresis can decrease CO, usually give furosemide or bumetanide IV, chronic therapy can lead to resistance

42

Vasodilators treatment for AHF

Nitroprusside reduces preload and SVR, but decrease BP and reflex tachy; Nitroglycerin most beneficial for pt with MI; Nesiritide used as 2nd or 3rd after nitro and diuretics, $$$$; enalaprilat only for stable pt; Hydralazine limited because of variances with pts

43

Dopamine for AHF

primarily a B and a agonist to increase CO, dose dependent, too low= inc renal blood flow and urine output, intermediate= inc HR, CO, high= vasoconstriction and inc BP; DOC for low BP/HF, no use for MI, vesicant

44

Dobutamine for AHF

B1 agonist w/ some B2 no a, inc CO, no effect on BP, short T1/2, give continuous infusion, first line for AHF

45

Milrinone for AHF

PDE-3 inhibitor, inhibits cGMP breakdown, inc contractility, artery and vein vasodilation, dec SVR, no change BP, reserved for pt who don't respond to other meds, T1/2=2-4 hours; continuous infusion, gets complicated

46

Goal for warm and wet/ treatment

reduce PCWP, diuretics and/or vasodilators, always IV because don't have time to wait

47

Goal for cool and dry/ treatment

inc CO, fluid and inotropic agents, start with fluids, once hydrated start inotrope, normotensive- dobutamine or milrinone; hypotensive- dopamine; if not at goal CO- vasodilator (IV)

48

Goal for cool and wet/ Treatment

reduce preload to reduce pulm congestion, incr CO to improve perfusion