chapter 51 - lehne

Diuretics

Essential for patients with fluid retention; fastest symptomatic improvement; helps correct fluid overload; should not be used alone.

Beta Blockers

Recommended first-line therapy for most patients; improves left ventricular ejection fraction; increases exercise tolerance; reduces hospitalization needs; prolongs survival.

Carvedilol (Coreg)

A key option among beta blockers for managing CHF.

Bisoprolol

A key option among beta blockers for managing CHF.

Metoprolol (Toprol XL)

A key option among beta blockers for managing CHF.

ACE Inhibitors

Used in combination with diuretics and beta blockers; helps manage fluid retention; important component of standard therapy.

ARBs

Used in combination with diuretics and beta blockers; helps manage fluid retention; important component of standard therapy.

Initial Cardiac Dysfunction

Reduced cardiac output triggers compensatory responses; decreased tissue perfusion initiates adaptive mechanisms.

Primary Compensatory Mechanisms

Includes cardiac dilation, sympathetic nervous system activation, renin-angiotensin-aldosterone system activation, and water and sodium retention.

RAAS Effects

Increases preload; enhances ventricular contractility; promotes fluid and sodium retention; stimulates aldosterone release; causes vasoconstriction.

Negative Consequences of Compensatory Mechanisms

Includes excessive heart rate leading to reduced ventricular filling, high arterial pressure decreasing cardiac output, elevated venous pressure causing pulmonary/peripheral edema, cardiac myocyte apoptosis, myocardial fibrosis, and ventricular remodeling.

Additional Maladaptive Responses

Includes increased endothelin production, release of inflammatory cytokines (TNF, IL-1), systemic inflammatory response, and progressive left ventricular dysfunction.

Stage A CHF

Patients at risk of developing Congestive Heart Failure; medications help prevent progression.

SGLT2 Inhibitors

Recommended for patients with diabetes and cardiovascular disease; reduces HF hospitalization risk by 27-35%.

Empagliflozin (Jardiance)

A key option among SGLT2 inhibitors.

Dapagliflozin (Farxiga)

A key option among SGLT2 inhibitors.

Canagliflozin (Invokana)

A key option among SGLT2 inhibitors.

Antihypertensive medications

Medications used to control high blood pressure.

Lipid-lowering agents

Medications that help reduce cholesterol levels in the blood.

Diabetes medications

Medications used to manage blood sugar levels in diabetic patients.

Rate control medications for supraventricular tachycardias

Medications that help manage heart rate in cases of rapid heartbeats originating above the ventricles.

Early intervention

The prompt initiation of treatment to prevent disease progression.

Medication therapy

The use of medications to treat or manage a condition.

Lifestyle modifications

Changes in daily habits and behaviors to improve health.

Regular monitoring

Consistent assessment of health conditions to ensure proper management.

Cardiotoxic medications

Medications that can cause damage to the heart.

Stage A: At Risk

No symptoms or structural heart disease, requiring interventions to control risk factors.

Stage B: Pre-Heart Failure

Structural heart disease without symptoms, requiring continued interventions from Stage A.

Stage C: Symptomatic Heart Failure

Structural heart disease with current or prior symptoms, requiring optimization of medication therapy.

Stage D: Advanced Heart Failure

Marked symptoms at rest despite maximal therapy, requiring close monitoring and possible advanced interventions.

NYHA Class II-III

Classification of heart failure severity based on symptoms and physical activity limitations.

Close monitoring of intake/output

Regular assessment of fluid intake and output to manage heart failure.

Daily weight checks

Regular measurement of body weight to monitor fluid retention in heart failure patients.

IV diuretics

Intravenous medications used to reduce fluid overload in heart failure patients.

Digoxin Toxicity

A condition resulting from excessive levels of digoxin, leading to various symptoms.

Gastrointestinal Effects of Digoxin Toxicity

Symptoms including anorexia, nausea, vomiting, and rarely diarrhea.

Central Nervous System Effects of Digoxin Toxicity

Symptoms including fatigue, confusion, and lethargy.

Visual Disturbances of Digoxin Toxicity

Symptoms including blurred vision, yellow-tinted vision, halos around dark objects, decreased visual acuity, and blind spots.

Cardiac Effects of Digoxin Toxicity

Symptoms including various dysrhythmias, AV block, ventricular flutter, and ventricular fibrillation.

Hypokalemia

A condition characterized by low potassium levels, which can contribute to digoxin toxicity.

Therapeutic range for digoxin

The acceptable blood concentration of digoxin, which is 0.5-0.8 ng/mL.

Absorption of Digoxin

Absorption varies between 60-80% and is best taken on an empty stomach.