Heart Failure – Part 3: Treatment Flashcards Preview

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Flashcards in Heart Failure – Part 3: Treatment Deck (26):
1

Specific HF Goals of Rx

Correction of the underlying cause of HF
Elimination of precipitating factors
Reduction of congestion
Improve blood flow

2

Reverses fluid retention (Na loss)
The most common HF therapy
Can be used chronically and acutely
Side effects: dehydration, hypokalemia, sulfa, tinnitis

Diuretics

3

Diuretics: Treatment of Volume Overload

inc Salt (+Water) Excretion
dec intravasc fluids
dec venous congestion
*dec dyspnea volume

4

…prils (lisinopril, enalapril, benazepril) are all?

ACE Inhibitors

5

ACE Inhibitors fx

Direct vasodilation
Decreased aldosterone activation

6

ACE Inhibitors side effects

Hypotension
Worsening renal function (afferent vasocontraction)
Hyperkalemia
Cough
Angioedema: <1%, can occur after months of use

7

…sartans (e.g. valsartan, candesartan, losartan)

ARBs

8

ARBs fx

Block the receptor of angiotensin II

9

ARBs do not produce kinin potentiation (________)
Otherwise side effects are similar to ACEI

no cough

10

Mineralocorticoid Receptor Antagonists (MRA) fx

Spironolactone and eplerenone
Effect: Block mineralocorticoid receptor

11

Mineralocorticoid Receptor Antagonists (MRA) side effects

Hyperkalemia (requires close monitoring)
Gynecomastia (spiro only)

12

…olols (metoprolol, carvedilol, bisoprolol)

Beta-Blockers

13

Beta-Blockers fx

Antagonize effect of sypathetic system (epinephrine/norepinephrine)

14

Beta-Blockers side effects

Negative inotrope: short-term loss for long-term gain
Fluid retention
Hypotension
Decreased cardiac output, even cardiogenic shock
Bronchoconstriction

15

Vasodilation
Salt / Water Excretion

ACE INHIBITORS / ANGIOTENSIN RECEPTOR BLOCKERS

16

Decreased Contractility
(May worsen symptoms)

BETA BLOCKERS

17

Salt / Water Excretion
Potassium retention

ALDOSTERONE RECEPTOR BLOCKADE

18

Abort sudden cardiac death from ventricular tachycardia / fibrillation
Patients with LVEF <=35% or prior

Electrical therapies - ICD
Implanted Cardioverter Defibrillators

19

ICD Cause the LV lateral wall and septal wall to contract together, which produces a more efficient:

contraction / ↑ stroke volume

20

IV diuresis
Nitrates (if BP allows)
CPAP/BiPAP

HFpEF
(LVEF > 40%)
Acute
(Unstable)

21

Control risk factors
DM, HTN, obesity
Control volume status

HFpEF
(LVEF > 40%)
Chronic
(Stable)

22

IV diuresis
Nitrates (if BP allows)
CPAP/BiPAP (if SOB)
Pressors (if ↓↓↓CO, shock)

HFrEF
(LVEF ≤ 40%)
Acute
(Unstable)

23

BB
ACEI/ARB
Aldosterone antagonist
Hydralazine / ISDN
+/- Digoxin
ICD/CRT

HFrEF
(LVEF ≤ 40%)
Chronic
(Stable)

24

HFrEF
(LVEF ≤ 40%)
Acute
(Unstable)

IV diuresis
Nitrates (if BP allows)
CPAP/BiPAP (if SOB)
Pressors (if ↓↓↓CO, shock)

25

HFrEF
(LVEF ≤ 40%)
Chronic
(Stable)

BB
ACEI/ARB
Aldosterone antagonist
Hydralazine / ISDN
+/- Digoxin
ICD/CRT

26

HFpEF
(LVEF > 40%)
Chronic
(Stable)

Control risk factors
DM, HTN, obesity
Control volume status