Therapeutics I > HF > Flashcards

HF Flashcards

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1
Q

What are the types of heart failure?

A
  1. Chronic HF
  2. Acute Decompensated HF
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2
Q

What is the difference between HFrEF and HFpEF?

A

REF: reduced systolic function (functional issue)
PEF: Diastolic dysfunction (structural issue)

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3
Q

What are the causes of HFrEF?

A
  1. Coronary artery disease
  2. Dilated cardiomyopathies
  3. Pressure overload
  4. Volume overload
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4
Q

What is the cause of HFpEF?

A
  1. Increased ventricular stiffness
  2. Valve stenosis
  3. Pericardial disease
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5
Q

What is heart failure?

A

A progressive disorder initiated by an event that impairs the ability of the heart to contract and or relax, resulting in a decrease in cardiac outpu

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6
Q

What is concentric hypertrophy?

A

Thickening of left ventricular walls
1. Pressure overload (HTN, aortic stenosis)
2. Leads to diastolic dysfunction

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7
Q

What is eccentric hypertrophy?

A

Stretching of left ventricular walls
1. Volume overload (mitral regurgitation)
2. Leads to systolic dysfunction

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8
Q

What is dilated cardiomyopathy?

A

Left ventricular remodeling
1. Mixed overload (ACS)
2. Leads to systolic dysfunction

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9
Q

What are cold sx?

A
  1. Cool extremities
  2. Fatigue
  3. Lethargy
  4. Hypotension
  5. Decreased renal function
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10
Q

What is wet symptoms?

A
  1. JVD
  2. S3
  3. Edema
  4. Ascites
  5. Rales
  6. Abdominojugular reflux
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11
Q

When do cold sx take place?

A
  1. CI lower than 2.2
  2. Low output and poor perfusion
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12
Q

What causes wet symptoms to take place?

A

Increased peripheral capillary wedge pressure greater than 22

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13
Q

What are the types of natriuretic peptides?

A

ANP, BNP, CNP

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14
Q

What are the functions of ANP and BNP?

A
  1. Promote natriuresis, diuresis and vasodilation
  2. Decreased aldosterone release and hypertrophy
  3. Inhibitor of SNS and RAAS
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15
Q

What is the function of CNP?

A

Promotes vasodilation

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16
Q

What are ANP and BNP located?

A

ANP: Produced in the atria from increased wall tension
BNP: Produced in ventricles from increased wall tension

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17
Q

What negative inotropic drugs will exacerbate HF?

A
  1. Antiarrhythmics
  2. Non-DHP CCB
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18
Q

What cardiotoxic drugs that will exacerbate HF?

A
  1. Doxorubicin, danorubicin, epirubicin, idarubicin (oncology)
  2. Amphetamines
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19
Q

What Na+ and H2O retention drugs exacerbate HF?

A
  1. NSAIDs
  2. COX2 inhibitors
  3. Estrogens
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20
Q

What is the difference between signs and symptoms?

A

Signs: Objective, what the professional sees
Symp: what the patient describes

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21
Q

When does peripheral edema become evident?

A

10 lb (4.5 kg) weight gain

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22
Q

What are the symptoms of HF? Asses the body

A
  1. Paroxysmal nocturnal dyspnea
  2. Exercise intolerance
  3. Dyspnea
  4. N
  5. Weight gain or loss
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23
Q

What are the signs of HF? Asses the body

A
  1. Ascites
  2. Pulmonary edema
  3. S3 gallop
  4. Peripheral edema
  5. JVD
  6. Wet symptoms
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24
Q

What are the tests used to diagnose HF?

A

BNP >35 pg/mL (ambulatory) or >100 pg/mL (hospitalization
Echocardiogram
1. Increase sCr
2. Electrocardiogram (impairment in conduction)
3. CBC
4. Chest x-ray (hypertrophy, fluid buildup)
5. Serum sodium <130 mEq/L (hyponatremia)

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25
What are the classifications of left ventricular ejection fraction (LVEF)?
HFpEF (preserved): ≥50% HFmrEF (mildly reserved): 41-49% HFrEF (reduced): ≤40% HFimpEF (improved): ≤40% and a follow up measurement of >40%
26
Why can't HF be diagnosed with just one test?
It's a clinical syndrome
27
What is the difference between stages and function classes of HF?
Stages deal with the integrity of the heart, patients can't move back Function is based on the patient ability to move, their signs and symptoms
28
What are the stages of HF? and what does each one mean?
A: At risk for HF. No structural sx B: Structural heart disease, but no sx C: Structural heart disease with prior or current sx D: Refractory HF requiring specialized intervention
29
What are the functional classes of HF? and what does each one mean?
I: No limitation II: No six w/ ordinary activity III: Slight limitation, comfortable at rest, sx w/ ordinary activity IV: Unable to carry on any physical activity w/o sx, sx at rest I: B I-IV: C IV: D
30
What is the goal of ACC/AHA staging?
Prevent progression to the next stage
31
What is the goal of functional classes?
Keep the patient symptom free in Class I
32
What makes someone at risk for HF?
1. Obesity 2. DM 3. Dyslipidemia
33
Why do we treat HF?
Decrease cardiac remodeling and reduced mortality and morbidity
34
What is treat for stage A HF? DM and CVD or risk of?
Optimize control of BP to reduce cormorbidities SGLTi
35
What are the non-pharm of HF?
1. Sodium reduction 2. Exercise/cardiac rehab 3. Weight loss 4. OSA treatment (CPAP) 5. Self-care (vaccines) 6. Devices
36
What is the purpose of HFpEF treatments?
**Treat comorbid conditions:** 1. Controlling HR and BP 2. Alleviate MI causes 3. Restore and maintain sinus rhythem in patients with A fib
37
What are treatments of HFpEF?
**Diuretics** SGLTi ARNI, MRA, ARB
38
What are the treamtments for HFmrEF?
**Diuretics** SGLT2i ACEi, ARB, ARNI MRA Evidence based beta-blockers for HFrEF
39
What do you use for HFrEF Stage C?
1. ARNi (II-III)/ ACEi /ARB (III-IV) 2. β-blocker 3. MRA 4. SGLT2 5. Diuretics
40
What is the option of HFrEF NYHA III-IV in black patients?
Hydral-nitrates (Bidil): Hydralazine and isosorbide dinitrate
41
What is the option of HFrEF NYHA I-III, LVEF <35%?
ICD
42
What is the options for HFrEF NYHA II-IV LVEF ≤35%; NSR and QRS ≥150 ms with LBBB?
CRT-D
43
What is an example of an ARNI?
Sacubitril/Valsartan (Entresto)
44
What are some things to consider about Entresto?
1. Cost 2. ACEi or ARB would be the best option if unaffordable 3. ALlow a 36 hr washout period from ACEi to Entresto
45
What are the beta blockers indicated for HF?
1. Bisoprolol (Zebeta) 2. Cardedilol (Coreg) 3. Metoprolol succinate (Toprel XL): QD
46
What are the MRAs indicated for HF?
1. Spiranolactone (Aldactone) 2. Eplerenone (Inspra)
47
What are the ADRs associated with MRAs? CIs?
1. Gynecomastia (Spironolactone) 2. Hyperkalemia 3. Renal dysfunction K+≥5 mEq/L or severe renal dysfunction
48
What are SGLT2i indications for HF and diabetes? MOA?
1. Empagliflozin (Jaurdiance) 2. Dapagliflozin (Farxiga) 3. Sotagliflozin (Inpefa) Decreases blood glucose and a mild diuretic
48
What is the treatment of stage B?
49
What diuretics are indicated for HF? 1st line?
Loops Thiazide are add on only
50
What is Bidil? Dosing? ADRs?
**Hydralazine and isosorbide dinitrate** 1. VD used only for AA 2. TID 3. DZ, HA, Gi destress
51
What med is used for NYHA II-III, HFrEF, HR ≥ 70 bpm, maximally tolerated beta blocker?
Ivabradine (Corlanor)
52
What do we add for recent HFH elevated NP levels, NYHA II-IV, or IV diuretics?
Vericiguat (Verquvo)
53
What do we use with symptomatic HFrEF?
Digoxin (Lanoxin)
54
What do you use for HF NYHA II-IV?
PUFA
55
When could you use potassium binders?
Patients with HF and severe hyperkalemia while taking RAASis?
56
What is the MOA of Ivabridnine? Dosing?
Corlanor is a SA node modulator that selectively inhibits If current (doesnt affect AV conduction, BP, or myocardial contractility) Only used for HR decreasing 2.5 mg BID or lower should not be used
57
ADRs of Ivabridine?
1. Bradycardia 2. A fib 3. Visual disturbances
58
What is the MAO of vericiguat? Are there an significnat ADRs?
sGC stimulator that increales cGMp production -> VD, imporvement in endothelial function, decrease in fibrosis, and remodeling of the heart No ADRs
59
What is the MAO of digoxin? Monitoring? Indications?
Increase PNS -> Decrease HR -> Enhanced diastolic filling Achieve plasma concentrations of 0.5 to 0.9 ng/mL (0.6-1.2 nmol/L). Higher than that -> increased toxicity Great for patients with Afib
60
What is PUFA?
Omega-3 Polyunsaturated Fatty acid Dyslipidemia and oxidative stress Minimal side effects
61
What is a Stage D patient?
1. ≥2 hospitalizations/year 2. Cardiac cachexia 3. ACEi iand beta blocker intolerance 4. SBP <90 5. Decline of Na+ <133 mEq/L 6. **Frequent implantable cardioverter defibrillator (ICD) shocks**
62
Non pharm for Stage D patients?
1. Address potential causes: thyroid disorder, pulmonary disorder, weight loss causes, non-adherence 2. Fluid restriction (1.5-2 L/d) 3. Mechaniscal circulatory support (MCS) 4. Cardiac transplantations
63
What is function of inotropes?
Increased HR helpign with contractility
64
How is the tritration regimen for HFrEF therapies?
1. Adjustment of therapies occurs Q1-2W 2. Achieve optimal GDMT withing 3-6 months of initial diagnosis (Up-titrate to max or target dose) 3. Reassesment of ventricular function occurs 3-6 months after target (max tolerated) doses of GDMT are achieved to determine need for device therapies
65
What are the things we look for in HF patient monitoring?
1. Clinical status (functional and volume) 2. BP 3. Kidney function and electrolytes (Decrease UO, Increasd sCr, Increased K+)
66
When do we refer a HF patient to a specialist?
Therapeutics I
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