Heart Failure Flashcards by Joshua Layton

What is the definition of heart failure?

Failure of the heart to pump blood to tissues

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What positive feedback system occurs w/ heart failure?

Structural remodeling

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What is the #1 cause of LT-HF? What are the two different types of this cause?

Ischemic heart disease

Coronary artery disease
Myocardial infarction

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What is the #1 cause of RT-HF?

LT-HF

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What can cause isolated chronic RT-HF? Acute RT-HF?

COPD

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What is another name for isolated Rt-HF? What does it mean?

Cor pulmonale

Lung disease that leads to RT-HF

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What is the duty of the RT side of the heart?

Receive blood from systemic circulation

Pump blood to lungs

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What is the duty of the LT side of the heart?

Receive oxygenated blood

Pump blood out to systemic circulation

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What is another name for HF? (CHF)

Congestive Heart Failure

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What are the Sx of LT-HF? What is it caused by?

paroxysmal nocturnal dyspnea
orthopnea
tachycardia
fatigue
SOB/dyspnea

pulmonary edema

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What are the Sx of RT-HF? What is it caused by?

JVD
ascites
hepatomegaly/splenomegaly
weight gain
dependent edema “pitting edema”

Systemic edema

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What are the 3 different types of HF? What do they each stand for?

HFpEF(HF w/ preserved EF)

HFrEF(HF w/ reduces EF)

HFmrEF(HF w/ mid range EF)

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What is normal EF?

50-65%

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What is the equation for figuring out EF%?

SV/ EDV= EF%

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What is the EF for a pt w/ HFrEF?

<40%

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What is the EF for a pt w/ HFpEF? How is this possible?

> 50%

SV is normal but EDV is low b/c of ventricular hypertrophy

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What is the general protocol for Tx of HF? How do each of them help w/ Sx of the pt?

diuretics-decrease edema
vasodilators-decrease workload on heart and redistribute edema
beta blockers-decrease tachycardia

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When are cardiac glycosides used?

When other medications for HF don’t work

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What are the 3 goals of drugs when Tx HF?

improve Sx
slow deterioration
reduce mortality

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What are the 3 homeostatic mechanisms to maintain fluid balance in the lungs?

Preload
LT ventricular contractility
Afterload

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What is the goal of drug therapy in Acute HF?

Optimize volume status

What is euvolemic?

Dehydrated body fluid level

What is the goal of diuretics in HF? What does this decrease?

Decrease the excess fluid by peeing it out?

Decreases preload

What are the 3 types of diuretics used for CHF?

Thiazides
Loops
K+ sparing

Why is there delayed diuretics w/ furosemide(Lasix)? What is given to increase the diuretics?

B/c the diuretics are emptying the edema from the body instead of the lung edema Give a vasodilator

What type of drugs are balance vasodilators?

ACEIs and ARBs

What effect is nitroglycerin going to have on pts preload and afterload? What route and dose is going to be best to cause these results?

Decrease preload and afterload High dose IV nitroglycerin

What does PDE5 and nitroglycerin cause in the body when taken together?

Severe drop in BP

What is the general protocol for Tx of pts w/ acute HF?

Vasodilator first (fluid redistribution) Diuretics next (fluid removal)

What is the goal of beta blockers for HF in the heart? In the kidneys?

Decrease BP Decrease workload on heart Decrease renin release

What does neprilysin breakdown?

ANP/BNP Bradykinin AT-2

What is digoxin(Lanoxin) used for? What are the 2 effects it causes on the heart?

HF A-fib Positive inotropic effect Negative chonotropic effect

What does digoxin(Lanoxin) cause positive inotropic effect?

Because of the blocked Na/K pump which increases Ca2+ in the heart=increasing contractility force

Why does digoxin(Lanoxin) cause a negative chronotropic effect?

Because it stimulates the vagus nerve which has more parasympathetic nerves=decreasing HR

What is another name of digitalization?

Loading dose

How is digoxin(Lanoxin) given?

Digitalization then maintenance

What is the normal levels of digoxin(Lanoxin) in the body?

0.5-2.0 nanograms/ml

What electrolyte levels increases the effect of digoxin(Lanoxin)?

Hypokalemia | Hypercalcemia

What is the normal levels for K+?

3.5-5.0mEq/L

What type of drugs should a pt increase their K+ intake?

Diuretics | Digoxin

What are the ADR of cardiac glycosides?

N/V Cardiac arrhythmia Disturbances in color (blurred and yellow fields of vision)

What levels should you monitor when a pt is on digoxin(Lanoxin)?

``` Serum digoxin (0.5-2.0ng/ml) K+ levels(3.5-5.0mEq/L) Apical pulse(above 60HR) ```

Why is beta-blockers given at low doses to pts in HF?

Because the decrease in SV and HR can increase the rate of HF

Why is hyperkalemia a ADR of ARNi drugs?

Because of the ARB that blocks aldosterone increase to get rid of K+

Why is Hypotension a ADR of ARNi drugs?

Because of the neprilysin inhibitor that drains a lot of fluid out of the body

What do SGLT-2 inhibitors end in?

-gliflozin

What is the MOA of SGLT-2 inhibitors? SOA? Indications?

Inhibits reabsorption of Na and glucose PCT HFrEF and DM

Before giving any dose of drug for HF, what must be done?

Count apical pulse for 1 min

What are the contraindications for HF drugs?

``` <60HR >100HR anorexia N/V Diarrhea Visual disturbances -yellow and green halos ```

What physical findings show positive therapeutic effects to drug Tx for HF?

Increased urine output Improved peripheral pulses, skin color and temperature Decrease dyspnea, SOB and edema