Heart failure Flashcards
How is diastolic HF treated?
diuretics, vasodilators, inotropic drugs, BB, hydralazine/nitrates
What care the common signs of HF?
systolic: cough, diastolic: jugular distention
Which stages of HF are at risk for HF?
A and B
Which stages of HF are in HF?
C and D
If in systolic HF, what is the first choice of drug therapy?
diuretic + ACEi, add BB if needed
If in systolic HF and ACEi + diuretic + BB isnt working, what should you add?
aldosterone antagonist or switch to ARB
If in systolic HF and diuretic + ACEi + BB + aldosterone antagonist arent working how should you treat?
digoxin, LVAD, transplant
define stage A HF
at risk for developing HF without structural heart disease or sxs
What are pts like with stage A HF?
HTN, atherosclerosis, diabetes, obesity, metabolic syndrome OR using cardiotoxins, FH
Define stage B HF
structural heart disease without sxs of heart failure
What are pts like with stage B HF?
previous MI, LV hypertrophy and low LVEF, asymptomatic valvular disease
Define stage C HF
structural heart disease with prior or current sxs of HF
What are patients like with stage C HF?
SOB, fatigue, reduced exercise tolerance
Define stage D HF
refractory HF requiring specialized interventions
What are pts like with stage D HF?
sxs at rest on maximum therapy, recurrent hospitalizations, require transplant
What is the proper order for staging HF?
A, B, C, I, II, III, IV, D
Describe stages I-IV of HF
I does well, II some DOE, III more DOE, IV SOB all the time
How is stage A HF treated?
Lifestyle mods (smoking cessation, no alcohol, exercise, fix lipids), Drugs: ACEi (diuretics only if obvious case of fluid problem)
How is stage B HF treated?
Lifestyle mods, ACEi + BB in appropriate pts, diuretics only if obvious fluid problem
How is stage C HF treated?
ACEi + BB + diuretic if needed, salt reduction, if refractory then digoxin or hydralazine/nitrates, aldosterone antagonists - biventricular pacing or defibrillators
How is stage D HF treated?
everything from A, B and C, end-of-life care, hospice, transplant, chronic ionotropes, permanent mechanical support
What are cautions when prescribing diuretics in HF?
doesn’t stop disease progression, don’t use alone, can overcorrect, can become resistant, thiazides don’t work
How is furosemide prescribed if pts are refractory?
continuous infusion, IV for pts in hospital (don’t forget to 1/2 the dose)
What type of HF benefits most from ACEi?
severe HF - may improve sxs in days or weeks
