HF

Question 1

Target doses for ACEI

Answer 1

Enalapril - 20 mg bid

Lisinopril - 40mg qday

Ramipril - 10 mg qday

Question 2

Target doses for ARB

Answer 2

Candesartan - 32 mg qday

Losartan - 50-100 mg qday

Valsartan - 160 mg bid

Question 3

Target doses for BB

Answer 3

Bisoprolol - 10 mg qday

Carvedilol - IR: 25 mg Po bid (< 85 kg); 50mg bid (>85kg)
CR: 80 mg qday

**Titrate dose every 2 weeks in outpatient setting; dose may be titrated quicker in hospital

Question 4

MRA dosing targets

Answer 4

Spironolactone - 25mg Qday

Eplerenone - 50mg qday

Question 5

ARNI target dose

Answer 5

Sacubitril/Valsartan - 97/103 mg (200mg) bid

Question 6

What medication exacerbate HF?

Answer 6

1. NSAIDs, COX-2 inhibitors, corticosteroids with mineralocorticoid properties (fludrocortisone)
2. NDHP CCB
3. Chemo drugs: doxorubicin/duanorubicin, trastuzumab/bevacizumab
4. Anti-diabetic meds; rosiglitazone, pioglitazone
5. Cilostazol

Question 7

What is stage A of HF and what are the therapies used?

Answer 7

Stage A= at high risk for HF but without structural heart disease or symptoms of HF
***pt has HTN, athrosclerotic disease, DM, Obesity, metabolic syndrome

Therapy:
Heart healthy lifestyle,
Drugs; ACEI or ARB and beta blocker as appropriate, treat co-morbid conditions

Question 8

What is stage B of HF and what are the therapies used?

Answer 8

Stage B= structural heart disease but without signs or symptoms of HF
**PT with pervious MI, LV remodeling LVH and low EF

Therapy:
Goal- prevent HR symptoms and further remodeling
Drugs: ACEI or ARB and BB as appropriate also treat co-morbid conditions

Question 9

What is stage 3 of HF and the therapies used to treat it?

Answer 9

Stage 3= structural heart disease with prior or current HF
***PT with known structural HD and HF signs and symptoms

HFpEF therapy :
ACEI/ARB with BB, use of diuretic and treat co-morbid conditions
**Select risk: use MRA

HFrEF therapy:
ACEI/ARB with BB, use of MRA (after first two are optimized) Diuretic, treat co-morbid conditions
**Select use: Hydralazine/ISDN, Digoxin, Ivabradine, CRT

**select use drugs are only used after you have optimized all other options and pt is still having issues

Question 10

What is stage D HF and what are the therapies used?

Answer 10

Refractory HF
**PT with HF symptoms at rest, recurrent hospitalizations despite GDMT

Therapy:
Control symptoms, heart transplant maybe even end of life care and hospice