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Chronic Heart Failure (Boards and Beyond) (Chronic HF (lots of therapies…
Chronic Heart Failure (Boards and Beyond)
Flow diagram for heart failure
Acute HF
symptom relief: loops, NG, inotropes
Chronic HF: still at risk for HF mortality or progression
Diastolic HF
Systolic HF
Chronic HF
lots of therapies for systolic HF
drugs
appreciate overactivation of 2 physiological systems
RAAS
increases
Na water retention
preload
TPR
Afterload
Blunt with
ACE inhibitors
ARBs
Both classes decrease mortality, hospitalizations
Side effects:
Hyperkalemia (decr aldosterone)
Renal failure (decrease GFR)
ACE inhibitors specifically
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ß blockers
negative inotropes
however very good in chronic systolic HF
NOT acute HF
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3 agents
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decrease mortality and hospitalizations
Aldosterone inhibitors
Spironolactone, Eplerenone
Spironolactone side effects
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Neprilysin Inhibitors
Sacubitril
Neprilisin degrades ANP/BNP
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marketed as Entresto: part valsartan
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Side effects:
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Ivabradine
Selective sinus node inhibitor
HF patients w/ higher HR have worse prognosis
Slow HR w/o decrease in CO, may be benefit
inhibits SA node funny current (If)
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Used in max dose BB's with high HR
SNS (ß1 Rc in heart)
block these and outcomes improve
Defib
biventricular pacemakers
lower mortality and halts progression
no direct therapies for diastolic HF
treat HTN, diabetes, Afib
monitor for congestion symptoms: diuretics
Device implants for chronic systolic heart failure
ICD Implantable cardiac defibrillator
sudden cardiac risk is as high as 20%
Mostly due to Vtach
Shocks heart , improves mortality
bleeding, infection risks
bad shocks
Biventricular pacemaker: CRT, BiV pacer
batteries connected to both walls of the ventricles, forcing synchronous contraction
in appropriate patients, improves mortality, reduces HF
