Treatment of Heart Failure Part 2 (Johnston) Flashcards
(50 cards)
Five basic principles of Heart Failure
- Make correct diagnosis-exclude mimics of HF
- Determine etiology of heart disease
- Determine precipitating factors
- Understand pathophysiology of HF
- Understand mechanism of action (MOA) of pharmacological therapy
Indications for admission to Hospital for Management of Heart Failure
- Acute myocardial ischemia
- Severe respiratory distress
- Hypoxia
- Hypotension
- Cardiogenic shock
- Anasarca–fluids accumulating everywhere
- Syncope
- Heart failure refractory to oral medications
Treatment of Heart Failure–non pharmacologic
- Quit smoking
- If overweight, decrease calorie intake, AHA diet, diet instructions by dietician to patient and spouse
- 2g Na diet
Other treatment for heart failure
- Fluid restriction if Na is less than 126 (less than 2 L/day)
- Avoid isometric activity–increases SVR and after load
- Encourage isotonic activity–walking, hiking, golf
- Stool softener–bc don’t want them to strain
- Subcut Lovenox–anticoagulant to prevent blood clots in thighs and pelvic area
- Oxygen for 24 hours
- Avoid alcohol–depresses contractility in cardiac disease
- Treat hypertension, hyperlipidemia, diabetes
Treatment and counseling before discharge from hospital
- Diet: patient with spouse/other; sodium restriction, calorie restriction if overweight; stimulants (coffee, tea)
- Education
- Rehab, exercise
- Medications: ACE/ARB, Beta blocker, ASA, statin, Nitro prn
2nd ICS LSB diastolic murmur indicates what kind of valvular disease?
-Aortic regurgitation
Options for treatment for hypotension/syncope for someone who is taking ARB, beta blocker and lasix
-Hold diuretics and reduce dose of ARB and beta blocker
CO=
SV x HR
Stroke volume is modulated by
- Preload
- Afterload
- Contractility
Conventional treatment for acute heart failure
- Decrease Diuretics–reduce fluid volume
- Decrease Vasodilators–decrease preload and/or after load
- Increase Ionotropes–augment contractility
Classification of recommendation–Evidence based medicine–Class I
-Evidence and/or agreement that therapy is beneficial, useful and/or effective; benefit 3+ risk
Classification of recommendation–Evidence based medicine–Class II (IIa vs IIb)
- conflicting evidence and/or divergence of opinion
- IIa) Weight of evidence/opinion in favor–benefit 2+ risk
- IIb) Less established evidence/opinion–benefit 1+ risk
Classification of recommendation–Evidence based medicine class III
-Evidence and/or agreement that therapy/prodcedure is NOT effective; may be harmful–no benefit
Classification of recommendation level of evidence: A
-Data from meta-analysis or multiple randomized clinical trials; multiple populations evaluated
Classification of recommendation level of evidence: B
-Data from single randomized trial or non-randomized studies; limited population evaluated
-Data from single randomized trial or non-randomized studies; limited population evaluated: C
-Only consensus of opinion of experts, case studies, or standard of care, very limited populations evaluated
Pharmacological treatment of heart failure
- ACE inhibitors or ARB
- Beta blockers
- Diuretics
- Spironolactone
- Digitalis
- IV ionotropes
- Hydralazine
- Nitrates
- CCB
- Sacubitril–valsartan Ivabradine
ACE inhibitors
- Block conversion of ANg1 to Ang II
- Useful for ALL NYHA functional classifications with SYSTOLIC heart failure
- Lower mortality and morbidity by 20% supported by several good drug trials
- Useful in preventing HF in high risk patients (ASHD, MD, HT) level of evidence A
- Recommend in patients with symptoms of HF, reduced EF, unless contraindicated: L of E: A
Use ACEI cautiously when
-renal insufficiency is present (creatinine greater than 2.5mg) or potassium greater than 5
ACEI absolute contraindications
- Pregnancy!!
- Angioedema
- Bilateral RAS (renal artery stenosis)
Side effect of ACEI
-cough
ACE vs ARB efficacy
- ARB is equivalent to ACE but not any better than ACE
- usually change from ACE due to cough
- ARB blocks AT1 and AT2
- ARB blocks AII at receptor without inhibiting kininase so don’t get cough because there is no accumulation of kinins that is present with ACEI
Don’t give ARB if
Patient had angioedema from ACE!
Beta blockers
- Survival benefit in chronic systolic HF and dilated cardiomyopathy
- Slow progression of disease and decrease hospitalization
- Improve cardiac performance and symptoms of HF
