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Flashcards in HF Rx 2 Deck (22):
1

ace inbhibitor receptor blockers, bet blockers and aldosterone receptor block all cause

1. anti-remodeling
2. decreased hypertropy
3. decreased fibrosis
4. decreased apoptosis
5. all reduce morbity and improve survival

2

what vasodilators can be used for HF?

1. arterial vasodilation (antihypertensives)
2. venous vasodilation (venodilators)
3. pulmonary arterial vasodilation

3

Arterial vasodilation (antihypertensives)
Possible benefits?

1. Decrease in LV afterload
2. Reduced cardiac work
3. Less mitral regurgitation

4

arterial vasodilation. Using hydralazine/isosirbide dinitrate in HFrEE

1. Hyd/ISDN < ACEI (V-HeFT II)
2. Hyd/ISDN+ACEI/BB in blacks good (A-HeFT)

5

Venous vasodilation (venodilators)
can cause

Decrease in preload

6

Pulmonary arterial vasodilation
can cause

Decrease in RV afterload

7

electrical therapies

1. implanted cardioverter Defibrilators
2. Cardiact resynchronization therapy

8

when do you use implanted cardioverter defibrilator?

1. patients with LVEF < 35%
2. prior dangerous heart rhythms
3. abort sudden cardiac death from ventricular tachycardia/fibrillation

9

when do you use CRT (cardiac resynchronization therapy?)

1. For patients with QRS duration > 120 msec (bundle brank block)
2. Cause the LV lateral wall and septal wall to contract together, which produces a more efficient contraction / ↑ stroke volume
3. Usually placed with ICD

10

Cardiac Resynchronization Therapy

1. Biventricular pacemakers (CRT or BiV)
2. LV lead placed through the coronary sinus

11

how do you improve symptoms of HFrEF?

1. Diuretics (furosemide)
2. Digitalis PO (HFrEF with shock - dobutamine, milronone)

12

how do you prolong survival for HFrEF?

1. ACE Inhibitors / Angiotensin Receptor Blockers
2. Beta Blockers
3. Aldosterone Receptor Antagonists
4. Other Vasodilators (hydralazine + nitrates)
5. Cardiac Resynchronization Therapy (biventricular pacing)
6. Implantable Cardioverter Defibrillator (ICD)

13

For a chronic (stable) pt with HFrEF wnad LVEF < 40%?

1. BB
2. ACEI/ARB
3. aldosterone antagonist
4. hydralazine/ISDN
5. +/- digoxin
6. ICD/CRT

14

Acute decompensated (hospitalized) HF treat with

1. IV diuretics
2. IV vasodilators (nitrates / nitroprusside, if BP allows)
3. Positive pressure ventilation (CPAP/BiPAP, intubation) for hypoxia
May also reduce preload
4. IV inotropes for shock only
5. May need to cut back on beta-blockers (only in severe cases)

15

Types of positive inotropic agents

1. Digoxin (PO) -
2. Dobutamine (IV)
3. Milrinone (IV)

16

Milrinone

(IV) – phosphodiesterase inhibitor (effect is similar to dobutamine)

17

Dobutamine

(IV) – β agonist (opposite of BB)

18

Digoxin

(PO) - K/Na exchange

19

Positive inotropic agents: clinical use: ACUTE:

1. IV agents used short term to reverse shock
2. Long-term they worsen remodeling

20

Positive inotropic agents: clinical use: Chronic:

1. Digoxin has no effect on mortality but may reduce symptoms and hospitalization (also some decrease in heart rate in AFib)
2. In high doses causes dig toxicity (mostly arrhythmias)

21

Beta-Agonism v. Antagonism: ACUTE v. CHRONIC

Acute: use epi, NE, dopamine, dubatamine

chronic: use carvedilol, metoprolo Succinate, Bisoprolol

22

options for end stage HFrEF

1. transplantation
2. mechanical support (LVAD)
(highly morbid)
3. inotrope infusion (may hasten death)
4. hospice