CHF

HEART FAILURE

Pathophysiologic state in which the heart fails to pump blood at a rate commensurate

HEART FAILURE

Occurs when cardiac output is inadequate to provide oxygen needed by the body

SYSTOLIC DYSFUNCTION

Inability of the heart to contract

DIASTOLIC DYSFUNCTION

Inability of the heart to relax

DYSPNEA

FATIGUE

RENAL RETENTION

Cardinal symptoms of heart failure

DYSPNEA

Symptoms that is low perfusion in the lungs

FATIGUE

Symptoms that is low blood perfusion in the periphery

TACHYCARDIA

SOB

CARDIOMEGALY

Sign & symptoms of HF

SYSTOLIC FAILURE

With reduced mechanical pumping action (contractility) & reduced ejection fraction

DIASTOLIC FAILURE

With stiffening & loss of adequate relaxation playing a major role in reducing filling & cardiac output

ARTERIOSCLEROTIC HEART DISEASE

HYPERTENSIVE HEART DISEASE

VALVULAR HEART DISEASE

Underlying cause/risk factors of HF

PAROXYSMAL NOCTURNAL DYSPNEA

RALES

S3 GALLOP

NECK VEIN DISTENTION

Major framingham criteria for the diagnosis of HF

NOCTURNAL COUGH

TACHYCARDIA

HEPATOMEGALY

Minor framingham criteria for diagnosis of HF

HIGH-OUTPUT FAILURE

Is a rare form of HF

HIGH-OUTPUT FAILURE

In this condition, the demands of the body are so great that even increased cardiac output is insufficient

HYPERTHYROIDISM

BERIBERI

ANEMIA

Causes of high-output failure

INCREASED SYMPATHETIC ACTIVITY

ACTIVATION OF RAAS

MYOCARDIAL HYPERTOPHY

3 compensatory physiological responses in HF

FLUID RETENTION

A fall in cardiac output decreases blood flow to the kidney, activating the RAAS

This leads to increased blood volume

MYOCARDIAL HYPERTROPPHY

Stretching of the heart muscle leads to a stronger contraction of the heart

2D ECHOCARDIOGRAPHY WITH DOPPLER

Most useful test evaluation of ejection fraction

Semi-quantitative assessment of LV size, function, wall motion abnormalities, valvular defects

2-L ECG

Assess cardiac rhythm, LV hypertrophy, prior MI

CHEST RADIOGRAPHY

Assess the cardiac size and shape and state of pulmonary vasculature

Identify non-cardiac causes of symptoms

CARDIAC BIOMARKERS (BNP)

Relatively sensitive markers for the presence of HF

Increased with age and renal impairment

CBC

Look or anemia, signs of infection, and bleeding

VASODILATORS

These drugs reduce load on the myocardium

DIURETICS

These drugs decreases extracellular fluid volume

INOTROPIC AGENTS

These drugs increase strength of myocardial contraction

ANGIOTENSIN-CONVERTING ENZYME INHIBITORS

The agents of choice in HF

PRELOAD

The volume of blood that fills the ventricle during diastole

AFTERLOAD

The pressure needed for the heart to pump blood into the arterial system

ACE INHIBITORS

Are useful in decreasing HF in asymptomatic patients with an ejection fraction of less than 35%

ACE INHIBITORS

Are prodrugs that require activation by hydrolysis via hepatic enzymes (except for captopril)

FOSINOPRIL

MOEXEPRIL

Renal elimination of the active moiety is important for most ACE inhibitors except for what drug

HYPERKALEMIA

PERSISTENT DRY COUGH

FETOTOXIC

ANGIOEDEMA

Adverse effect of ACE inhibitors

LOSARTAN

Prototype of ARBs

ARBs

Alternative for patients intolerant with ACE inhibitors

CARVEDILOL

METOPROLOL

It is a beta blocker drug that is used commonly for CH

HYDRALAZINE WITH ISOSORBIDEDINITRATE

These drugs are most commonly used if the patient is intolerant of ACE and BB

NESIRITIDE

Synthetic form f the endogenous peptide brain natriuretic peptide

Approved for use in acute (not chronic) cardiac failure

BOSENTAN

TEZOSENTAN

Competitive inhibitors of endothelin

It has significant teratogenic and hepatotoxic effects

65-80%

Oral absorption of Digoxin

ISTAROXIME

An investigational steroid derivative that increases contractility by inhibiting Na+ /K + -ATPase but in addition facilitates sequestration of Ca2+ by the Sr

DOBUTAMINE

Leads to an increase in cAMP which results in increase of protein kinase which phosphorylates slow calcium channel thus increasing the amount of calcium ion entry

DOPAMINE

Has also been used in acute heart failure and may be particularly helpful if there is a need to raise blood pressure

LEVOSIMENDAN

A drug that sensitizes the troponin system to calcium

Inhibits phosphodiesterase

Cause some vasodilation

DIURETICS

They have no direct effect on cardiac contractility; their major MOA in heart failure is to reduce venous pressure & ventricular preload

SPIRONOLACTONE/EPLERENONE

For patients having advanced heart disease

Not be taken with patients taking potassium supplement

CARDIAC RESYNCHRONIZATION THERAPY (CRT)

Device used to restore synchrony of the left ventricle in patients with HF and a widened QRS complex

IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR (ICD)

Device to treat tachyarrhythmias for primary/secondary prophylaxis against sudden cardiac death