Flashcards in Medical Treatment of Heart Failure Deck (17):
1. Identify the pathophysiologic processes that medical therapy may interrupt and sometimes reverse in a patient with systolic heart failure.
reduction in contractility causes hypo perfusion and activation of the RAS system as well as SNS and neurohormonal systems because unlike a normal heart, a diseased heart cannot maintain CO so body tries to compensate with excess fluid
2. What are the acute and chronic effects of diuretics in heart failure? What type of diuretic is best?
acute: sodium excretion, ventilation (reduces filling pressures)
chronic: will not stop progression of the disease but can help maintain a normal volume state; use loop diuretic- most effective in getting rid of volume
2. What is the benefit of balanced vasodilator in treating heart failure?
ACE-Is can reduce the after load; has been shown to reduce disease progression and the whole class reduces mortality
2. Why would you prescribe a B-blocker?
decreased effects of cardiac sympathetic activity and decreased renal sympathetic activity (decreased sodium retention)
must prescribe: metoprolol succinate, bisoprolol and carvedilol: shown to reduce mortality, reduce hospitalization and increase LV ejection fraction as well as reverse the process of remodeling of LV
Describe how to begin therapy with heart failure.
best to start ACE-I to address symptoms, beta blockers may make symptoms worse when first up titrated
combined effect of ACE i and BB is the most important therapy for systolic HF
Which would you use ARB or ACEI?
more evidence for ACEI although ARBs are as effected and a good substitute for patients with adverse side effects (cough or angioedema)- no significant advantage using both together
Aldosterone antagonist can help to treat _______ ______. What benefits does this therapy have?
aldosterone escape, shows benefit on top of other treatments by reducing vasoconstriction, reduce fibrosis and reentry rhythms and inflammation; reduce mortality
it is effective in severe, post MI and moderate heart failure
What is the major risk of aldosterone antagonists?
When would you prescribe digoxin?
when systolic dysfunction is present and symptoms persist despite use of diuretics beta blockers, renin-angiotensin-aldosterone inhibitors, or when atrial fibrillation and heart failure are present
danger of heart block with bradycardia as well as ectopic and reentrant arrhythmia
What drug would you consider augmenting for treatment of African Americans in heart failure?
isosorbide denigrate plus hydralazine
Most patients who suffer sudden cardiac death are patients who have more/less severe disease.
less severe, patients who are minimally symptomatic with class II heart failure suffer most from sudden cardiac death and in these patients you might consider an assist device to improve synchrony of ventricles (improvement in 70% of patients
What treatments would you suggest for someone in acute heart failure with shock?
require IV dose because congestion in bowel decreases absorption: dobutamine, dopamine, milrionine and furosemide
Milrinone mechanisms and effects?
phophodiesterase inhibitor that causes an increase in contractility and directly vasodilates both arteries and veins
used in patients with congestion and low output and known systolic dysfunction
Doubutamine mechanism and action?
stimulates beta receptors to cause increase in inotropy
best reserved for patients with severe systolic dysfunction and evidence of poor end organ perfusion
What are the effects of dopamine?
vasoconstriction at high doses
positive inotropic and chronotrope
reserve for patients with hypotension and congestion and poor end organ perfusion
No evidence that inotropic drugs are beneficial in patient with ____ with good end organ perfusion. Use in patients with low BP, poor output combined with _____-