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Flashcards in Heart Failure Info Deck (26):
0

Left heart failure

Thin and weAk
Fluid buildup in lungs
Kikexic
Increased PCWP
Cough
Fatigue
Tachycardia
Body not adequately perfused

1

Right heart failure

Fluid buildup in abdomen
Ascites
Fatigue
Anorexia
Enlarged liver and spleen
Swelling hands and fingers
Distended jugular veins

2

Symptomatic definition of HF

Mismatch between right and left heart volume outputs

3

Cardio centric definition of HF

Hearts inadequate ability to fill with or eject blood

4

Systolic HF

Decreased contractility and EF
Use Batista procedure

5

Diastolic HF

Decreased ventricular filling and cardiac output

6

Options for CHF

Heart transplant, VAS, or death

7

Main HF causes

Ischemia
Idiopathic
Viral
Immune mediated
HTN

8

Ischemic HF

Most common (70%)

9

Viral HF

Viruses don't primarily attack myocardium, errantly end up there
Can cause cardiomyopathy
May require valvular surgery

10

Forces contributing to worsening HF

SNS and PSNS
Renin angiotensin aldosterone system

11

Goals of HF therapy

Improve/alleviate symptoms
Slow downhill slide toward transplant/VaD/death
Improve survival
Increase QALYs

12

QALYs improving drugs

Positive inotropes
Diuretics
Renin/angiotensin blockers
Primary vasodilators
Beta blockers
Aldosterone antagonists

13

Positive inotropes

Cardiac glycosides
Cathecholamines
Bypiridiney

14

Digitalis MOA

Blocks Na/K pump

15

Nickname for bipyridines

Phosphodiesterase inhibitors

16

Bipyridines action

Increase cAMP, increase Ca, increase contractility
Long term has high mortality!!! Only use on short term acute HF (pt struggling to come off bypass)

17

Effects of diuretics

No direct effect on heart
Decreased preload, afterload, and edema
Net affect is decreased workload so decreased O2 demand

18

Effects of ACE inhibitors

Decreased venous tone, decreased SVR, preload, afterload, and BP

19

Patients intolerant to ACE inhibitors and ARBs respond to...

Hydralazine (Apresoline) and Isosorbide (Isordil)

20

Effect of beta blockers

Block chronic SNS that leads to apoptosis and remodeling
Decreases O2 demand

21

Beta blockers with long term HF survivability

Metoprolol (Lopressor, Toprol XL)
Carvedilol (Coreg)

22

LCZ696

50/50 mix Losartan and Sacubitril
Nephrilysin inhibitor

23

Stages of CHF

A: high risk, no symptoms (treat obesity, diabetes, HTN, etc)
B: symptom with severe exercise (ACE, ARB, diuretic, beta blocker)
C: symptoms with marked exercise (add digoxin, aldosterone antagonist, Hydralazine, nitrate)
D: severe symptoms at rest (LVAD, transplant)

24

Best drug combination for CHF

Digoxin, diuretic, amd ACE inhibitor

25

Effects of morphine

Lowers respiratory rate
Decreases preload and afterload
Eases anxiety