Heart Failure – Part 3:Treatment

Question 1

Specific HF Goals of Rx

Answer 1

Correction of the underlying cause of HF
Elimination of precipitating factors
Reduction of congestion
Improve blood flow

Question 2

Reverses fluid retention (Na loss)
The most common HF therapy
Can be used chronically and acutely
Side effects: dehydration, hypokalemia, sulfa, tinnitis

Answer 2

Diuretics

Question 3

Diuretics:Treatment of Volume Overload

Answer 3

inc Salt (+Water) Excretion
dec intravasc fluids
dec venous congestion
*dec dyspnea volume

Question 4

…prils (lisinopril, enalapril, benazepril) are all?

Answer 4

ACE Inhibitors

Question 5

ACE Inhibitors fx

Answer 5

Direct vasodilation

Decreased aldosterone activation

Question 6

ACE Inhibitors side effects

Answer 6

Hypotension
Worsening renal function (afferent vasocontraction)
Hyperkalemia
Cough
Angioedema: <1%, can occur after months of use

Question 7

…sartans (e.g. valsartan, candesartan, losartan)

Answer 7

ARBs

Question 8

ARBs fx

Answer 8

Block the receptor of angiotensin II

Question 9

ARBs do not produce kinin potentiation (________)

Otherwise side effects are similar to ACEI

Answer 9

no cough

Question 10

Mineralocorticoid Receptor Antagonists (MRA) fx

Answer 10

Spironolactone and eplerenone

Effect: Block mineralocorticoid receptor

Question 11

Mineralocorticoid Receptor Antagonists (MRA) side effects

Answer 11

Hyperkalemia (requires close monitoring)

Gynecomastia (spiro only)

Question 12

…olols (metoprolol, carvedilol, bisoprolol)

Answer 12

Beta-Blockers

Question 13

Beta-Blockers fx

Answer 13

Antagonize effect of sypathetic system (epinephrine/norepinephrine)

Question 14

Beta-Blockers side effects

Answer 14

Negative inotrope: short-term loss for long-term gain
Fluid retention
Hypotension
Decreased cardiac output, even cardiogenic shock
Bronchoconstriction

Question 15

Vasodilation

Salt / Water Excretion

Answer 15

ACE INHIBITORS / ANGIOTENSIN RECEPTOR BLOCKERS

Question 16

Decreased Contractility

May worsen symptoms

Answer 16

BETA BLOCKERS

Question 17

Salt / Water Excretion

Potassium retention

Answer 17

ALDOSTERONE RECEPTOR BLOCKADE

Question 18

Abort sudden cardiac death from ventricular tachycardia / fibrillation
Patients with LVEF <=35% or prior

Answer 18

Electrical therapies - ICD

Implanted Cardioverter Defibrillators

Question 19

ICD Cause the LV lateral wall and septal wall to contract together, which produces a more efficient:

Answer 19

contraction / ↑ stroke volume

Question 20

IV diuresis
Nitrates (if BP allows)
CPAP/BiPAP

Answer 20

HFpEF
(LVEF > 40%)
Acute
(Unstable)

Question 21

Control risk factors
DM, HTN, obesity
Control volume status

Answer 21

HFpEF
(LVEF > 40%)
Chronic
(Stable)

Question 22

IV diuresis
Nitrates (if BP allows)
CPAP/BiPAP (if SOB)
Pressors (if ↓↓↓CO, shock)

Answer 22

HFrEF
(LVEF ≤ 40%)
Acute
(Unstable)

Question 23

BB
ACEI/ARB
Aldosterone antagonist
Hydralazine / ISDN
\+/- Digoxin
ICD/CRT

Answer 23

HFrEF
(LVEF ≤ 40%)
Chronic
(Stable)

Question 24

HFrEF
(LVEF ≤ 40%)
Acute
(Unstable)

Answer 24

IV diuresis
Nitrates (if BP allows)
CPAP/BiPAP (if SOB)
Pressors (if ↓↓↓CO, shock)

Question 25

HFrEF
(LVEF ≤ 40%)
Chronic
(Stable)

Answer 25

BB
ACEI/ARB
Aldosterone antagonist
Hydralazine / ISDN
\+/- Digoxin
ICD/CRT

Question 26

HFpEF
(LVEF > 40%)
Chronic
(Stable)

Answer 26

Control risk factors
DM, HTN, obesity
Control volume status