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Therapeutics I > HF > Flashcards

HF Flashcards

1
Q

What are the types of heart failure?

A
  1. Chronic HF
  2. Acute Decompensated HF
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2
Q

What is the difference between HFrEF and HFpEF?

A

REF: reduced systolic function (functional issue)
PEF: Diastolic dysfunction (structural issue)

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3
Q

What are the causes of HFrEF?

A
  1. Coronary artery disease
  2. Dilated cardiomyopathies
  3. Pressure overload
  4. Volume overload
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4
Q

What is the cause of HFpEF?

A
  1. Increased ventricular stiffness
  2. Valve stenosis
  3. Pericardial disease
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5
Q

What is heart failure?

A

A progressive disorder initiated by an event that impairs the ability of the heart to contract and or relax, resulting in a decrease in cardiac outpu

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6
Q

What is concentric hypertrophy?

A

Thickening of left ventricular walls
1. Pressure overload (HTN, aortic stenosis)
2. Leads to diastolic dysfunction

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7
Q

What is eccentric hypertrophy?

A

Stretching of left ventricular walls
1. Volume overload (mitral regurgitation)
2. Leads to systolic dysfunction

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8
Q

What is dilated cardiomyopathy?

A

Left ventricular remodeling
1. Mixed overload (ACS)
2. Leads to systolic dysfunction

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9
Q

What are cold sx?

A
  1. Cool extremities
  2. Fatigue
  3. Lethargy
  4. Hypotension
  5. Decreased renal function
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10
Q

What is wet symptoms?

A
  1. JVD
  2. S3
  3. Edema
  4. Ascites
  5. Rales
  6. Abdominojugular reflux
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11
Q

When do cold sx take place?

A
  1. CI lower than 2.2
  2. Low output and poor perfusion
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12
Q

What causes wet symptoms to take place?

A

Increased peripheral capillary wedge pressure greater than 22

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13
Q

What are the types of natriuretic peptides?

A

ANP, BNP, CNP

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14
Q

What are the functions of ANP and BNP?

A
  1. Promote natriuresis, diuresis and vasodilation
  2. Decreased aldosterone release and hypertrophy
  3. Inhibitor of SNS and RAAS
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15
Q

What is the function of CNP?

A

Promotes vasodilation

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16
Q

What are ANP and BNP located?

A

ANP: Produced in the atria from increased wall tension
BNP: Produced in ventricles from increased wall tension

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17
Q

What negative inotropic drugs will exacerbate HF?

A
  1. Antiarrhythmics
  2. Non-DHP CCB
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18
Q

What cardiotoxic drugs that will exacerbate HF?

A
  1. Doxorubicin, danorubicin, epirubicin, idarubicin (oncology)
  2. Amphetamines
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19
Q

What Na+ and H2O retention drugs exacerbate HF?

A
  1. NSAIDs
  2. COX2 inhibitors
  3. Estrogens
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20
Q

What is the difference between signs and symptoms?

A

Signs: Objective, what the professional sees
Symp: what the patient describes

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21
Q

When does peripheral edema become evident?

A

10 lb (4.5 kg) weight gain

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22
Q

What are the symptoms of HF? Asses the body

A
  1. Paroxysmal nocturnal dyspnea
  2. Exercise intolerance
  3. Dyspnea
  4. N
  5. Weight gain or loss
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23
Q

What are the signs of HF? Asses the body

A
  1. Ascites
  2. Pulmonary edema
  3. S3 gallop
  4. Peripheral edema
  5. JVD
  6. Wet symptoms
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24
Q

What are the tests used to diagnose HF?

A

BNP >35 pg/mL (ambulatory) or >100 pg/mL (hospitalization
Echocardiogram
1. Increase sCr
2. Electrocardiogram (impairment in conduction)
3. CBC
4. Chest x-ray (hypertrophy, fluid buildup)
5. Serum sodium <130 mEq/L (hyponatremia)

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25
Q

What are the classifications of left ventricular ejection fraction (LVEF)?

A

HFpEF (preserved): ≥50%
HFmrEF (mildly reserved): 41-49%
HFrEF (reduced): ≤40%
HFimpEF (improved): ≤40% and a follow up measurement of >40%

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26
Q

Why can’t HF be diagnosed with just one test?

A

It’s a clinical syndrome

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27
Q

What is the difference between stages and function classes of HF?

A

Stages deal with the integrity of the heart, patients can’t move back

Function is based on the patient ability to move, their signs and symptoms

28
Q

What are the stages of HF? and what does each one mean?

A

A: At risk for HF. No structural sx
B: Structural heart disease, but no sx
C: Structural heart disease with prior or current sx
D: Refractory HF requiring specialized intervention

29
Q

What are the functional classes of HF? and what does each one mean?

A

I: No limitation
II: No six w/ ordinary activity
III: Slight limitation, comfortable at rest, sx w/ ordinary activity
IV: Unable to carry on any physical activity w/o sx, sx at rest

I: B
I-IV: C
IV: D

30
Q

What is the goal of ACC/AHA staging?

A

Prevent progression to the next stage

31
Q

What is the goal of functional classes?

A

Keep the patient symptom free in Class I

32
Q

What makes someone at risk for HF?

A
  1. Obesity
  2. DM
  3. Dyslipidemia
33
Q

Why do we treat HF?

A

Decrease cardiac remodeling and reduced mortality and morbidity

34
Q

What is treat for stage A HF? DM and CVD or risk of?

A

Optimize control of BP to reduce cormorbidities

SGLTi

35
Q

What are the non-pharm of HF?

A
  1. Sodium reduction
  2. Exercise/cardiac rehab
  3. Weight loss
  4. OSA treatment (CPAP)
  5. Self-care (vaccines)
  6. Devices
36
Q

What is the purpose of HFpEF treatments?

A

Treat comorbid conditions:
1. Controlling HR and BP
2. Alleviate MI causes
3. Restore and maintain sinus rhythem in patients with A fib

37
Q

What are treatments of HFpEF?

A

Diuretics
SGLTi
ARNI, MRA, ARB

38
Q

What are the treamtments for HFmrEF?

A

Diuretics
SGLT2i
ACEi, ARB, ARNI
MRA
Evidence based beta-blockers for HFrEF

39
Q

What do you use for HFrEF Stage C?

A
  1. ARNi (II-III)/ ACEi /ARB (III-IV)
  2. β-blocker
  3. MRA
  4. SGLT2
  5. Diuretics
40
Q

What is the option of HFrEF NYHA III-IV in black patients?

A

Hydral-nitrates (Bidil): Hydralazine and isosorbide dinitrate

41
Q

What is the option of HFrEF NYHA I-III, LVEF <35%?

A

ICD

42
Q

What is the options for HFrEF NYHA II-IV LVEF ≤35%; NSR and QRS ≥150 ms with LBBB?

A

CRT-D

43
Q

What is an example of an ARNI?

A

Sacubitril/Valsartan (Entresto)

44
Q

What are some things to consider about Entresto?

A
  1. Cost
  2. ACEi or ARB would be the best option if unaffordable
  3. ALlow a 36 hr washout period from ACEi to Entresto
45
Q

What are the beta blockers indicated for HF?

A
  1. Bisoprolol (Zebeta)
  2. Cardedilol (Coreg)
  3. Metoprolol succinate (Toprel XL): QD
46
Q

What are the MRAs indicated for HF?

A
  1. Spiranolactone (Aldactone)
  2. Eplerenone (Inspra)
47
Q

What are the ADRs associated with MRAs? CIs?

A
  1. Gynecomastia (Spironolactone)
  2. Hyperkalemia
  3. Renal dysfunction

K+≥5 mEq/L or severe renal dysfunction

48
Q

What are SGLT2i indications for HF and diabetes? MOA?

A
  1. Empagliflozin (Jaurdiance)
  2. Dapagliflozin (Farxiga)
  3. Sotagliflozin (Inpefa)

Decreases blood glucose and a mild diuretic

48
Q

What is the treatment of stage B?

A
49
Q

What diuretics are indicated for HF? 1st line?

A

Loops
Thiazide are add on only

50
Q

What is Bidil? Dosing? ADRs?

A

Hydralazine and isosorbide dinitrate
1. VD used only for AA
2. TID
3. DZ, HA, Gi destress

51
Q

What med is used for NYHA II-III, HFrEF, HR ≥ 70 bpm, maximally tolerated beta blocker?

A

Ivabradine (Corlanor)

52
Q

What do we add for recent HFH elevated NP levels, NYHA II-IV, or IV diuretics?

A

Vericiguat (Verquvo)

53
Q

What do we use with symptomatic HFrEF?

A

Digoxin (Lanoxin)

54
Q

What do you use for HF NYHA II-IV?

A

PUFA

55
Q

When could you use potassium binders?

A

Patients with HF and severe hyperkalemia while taking RAASis?

56
Q

What is the MOA of Ivabridnine? Dosing?

A

Corlanor is a SA node modulator that selectively inhibits If current (doesnt affect AV conduction, BP, or myocardial contractility)

Only used for HR decreasing

2.5 mg BID or lower should not be used

57
Q

ADRs of Ivabridine?

A
  1. Bradycardia
  2. A fib
  3. Visual disturbances
58
Q

What is the MAO of vericiguat? Are there an significnat ADRs?

A

sGC stimulator that increales cGMp production -> VD, imporvement in endothelial function, decrease in fibrosis, and remodeling of the heart

No ADRs

59
Q

What is the MAO of digoxin? Monitoring? Indications?

A

Increase PNS -> Decrease HR -> Enhanced diastolic filling

Achieve plasma concentrations of 0.5 to 0.9 ng/mL (0.6-1.2 nmol/L). Higher than that -> increased toxicity

Great for patients with Afib

60
Q

What is PUFA?

A

Omega-3 Polyunsaturated Fatty acid

Dyslipidemia and oxidative stress
Minimal side effects

61
Q

What is a Stage D patient?

A
  1. ≥2 hospitalizations/year
  2. Cardiac cachexia
  3. ACEi iand beta blocker intolerance
  4. SBP <90
  5. Decline of Na+ <133 mEq/L
  6. Frequent implantable cardioverter defibrillator (ICD) shocks
62
Q

Non pharm for Stage D patients?

A
  1. Address potential causes: thyroid disorder, pulmonary disorder, weight loss causes, non-adherence
  2. Fluid restriction (1.5-2 L/d)
  3. Mechaniscal circulatory support (MCS)
  4. Cardiac transplantations
63
Q

What is function of inotropes?

A

Increased HR helpign with contractility

64
Q

How is the tritration regimen for HFrEF therapies?

A
  1. Adjustment of therapies occurs Q1-2W
  2. Achieve optimal GDMT withing 3-6 months of initial diagnosis (Up-titrate to max or target dose)
  3. Reassesment of ventricular function occurs 3-6 months after target (max tolerated) doses of GDMT are achieved to determine need for device therapies
65
Q

What are the things we look for in HF patient monitoring?

A
  1. Clinical status (functional and volume)
  2. BP
  3. Kidney function and electrolytes (Decrease UO, Increasd sCr, Increased K+)
66
Q

When do we refer a HF patient to a specialist?

A

Therapeutics I (32 decks)

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