CHF lab values
- LFTs (ALT/AST) elevated –> indicative of congestive hepatopathy
- Elevated troponin
- elevated BNP (brain natriuretic peptide)
- ECHO
- Imaging: MRI, EKG, Chest Xray
- CBC
- urinalysis
- serum Ca and Mg
- serum Cr
- glucose
- Lipids (LDL, HDL)
- thyroid functioning hormone
CHF Vasodilator therapy
- IF hypertensive (SBP >100) in presence of acute pulmonary edema–> NTG or nitroprusside should be considered
- IF hypotensive (SBP<100)–> consider vasodilators (
ADHF Low Perfusion regimen
- inotropes increase contractility then increase cardiac output
- Dobutamine (B1 agonist~ increase contractility and HR) & milrinone (has vasodilator properties ~ PDEIII inhibitor, increase cAMP)
ADHF Volume Overload regimen
- decrease volume
- loop diuretics (furosemide, bumetanide)
- thiazide diuretics (hydrochlorothiazide, chlorothiazide)
CHF S/SX
- cough, SOB, weakness, hypoxia, S3 gallop: abnormal heart sounds, low perfusion, PND, pulmonary rales, weight gain, peripheral edema, JVD, HJR, hepatomegaly
HF Meds
- ACEI/ARB
- If not, Entresto (Sacubitril/Valsartan)
- BB (Carvedilol or Metoprolol XR)
- Spironolactone (aldosterone receptor antagonist)
- Loop Diuretic: Furosemide
- Hydralazine : add on therapy for AA who have EF <40% or symptomatic HF
- Digoxin for HFrEF patients who need extra rate control
- goal: 0.5-0.9 ng/ml
ACEI MOA
prevents left ventricular remodeling reduce formation of angiotensin II - reduces after load and preload - vasodilation and improves EF - reduced hospitalizations
ARB MOA
blocks binding angiotensin II to AT1 receptors in heart, kidneys, and blood vessels
- inhibits remodeling
- preload and afterload reduction
- vasodilation and improved EF
BB MOA
control HR and reduce arrhythmia
- metoprolol: blocks B1 receptors
- carvedilol: blocks B1 and 2 & alpha receptors
reduce workload of the heart by slowing down rate and reducing contractility
Hydralazine MOA
release NO, increasing cGMP, relaxing SM of blood vessels
-relaxes SM of blood vessels and dilates both veins and arteries
Spironolactone MOA
Aldosterone antagonist
K+ sparing diuretic
-helps keep your body from absorbing too much salt and keeps your K+ levels from getting too low
Furosemide MOA
Inhibition of the Na/K/Cl transporter in the thick ascending loop of Henle
Vitamin D MOA
Regulates gene transcription via the vitamin D receptor
-for osteoporosis, Vitamin D deficiency rickets, osteomalacia, psoriasis
SE= hypercalcemia, hypercalciuria, hyperphosphatemia
