HF/ Diuretics meds

What are some commone causes of Heart failure?

 Myocardial (myocardium) disease or damage.

• cardiomyopathy

CAD

Ischemia

Systemic/Pulmonary hypertension

Valuar heart disease

If the heart can’t conctract properly is that Systolic or diastolic dysfunction? what if the heart can fill properly ?

Systolic dysfunction = the heart can't contract properly.

Diastolic dysfunction = the heart can't fill properly with blood

Define Pre and after load

Pre -> the vol. of BL received from the heart, and it deals with the stretch of the ventricle

After -> The pressure the heart has to overcome to pump (like squeezing a water hose half shut)

Since HF leads to ? CO, the body will activate neurohormonal mechanisms to ? the BP so all tissue will get that 4-6L/min of blood.

? activation (? and ?) & ? system active = ? BP

As workload ?, cardiac muscle fibers weaken and lose contractility. The heart tries to compensate by ? the heart muscle (?).

Since HF leads to Low CO, the body will activate neurohormonal mechanisms to increase the BP so all tissue will get that 4-6L/min of blood.

SNS activation (NoriEpi and EPI) & RAAS system active = increased BP

As workload increases, cardiac muscle fibers weaken and lose contractility. The heart tries to compensate by thickening the heart muscle (ventricular hypertrophy).

Left HF S/Sx: DO CHAP and how do you treat O?

Dyspnea

Orthopnea

• Tx. with elevated head w/ pillow

Cough

Hemoptysis (blood sputum)

Adventitious Breathing sounds

Pulmonary congestion

Right HF S/Sx: AW HEAD

Anorexia and nausea

Weight gain

Hepatomegaly (Liver dysfxn)

Bipedal Edema

Ascites (edema in abdominal cavity)

Distended neck vein/JVD

What is ventricular remodeling?

Over time, angiotensin II and aldosterone (RAAS) lead to fibrosis (scarring) and ventricular hypertrophy known as ventricular remodeling, which worsens heart failure.

What are the 4 side effects of HF therapies (Diuretics)? Please provided a short description

Hypokalemia.

• Excessive and repeated diuresis can lead to hypokalemia.

Hyperkalemia

• may occur with the use of ACE inhibitors, ARBs, or spironolactone.

Hyponatremia

• Prolonged diuretic therapy results in disorientation, fatigue, apprehension, weakness, and muscle cramps.

Dehydration and hypotension.

• Volume depletion from excessive fluid loss may lead to dehydration and hypotension.

Define

PVCs (premature ventricular contractions)

Ventricular fibrillation(V fib)

Ventricular tachycardia (V tach)

• PVCs (premature ventricular contractions) -> Common + no symptoms

  • Caused: Exercise, caffeine, anxiety...can cause cardiomyopathy if frequent

• Ventricular fibrillation(V fib) -> Chaotic heart beats

  •  Deadly + Most common cause sudden cardiac death

• Ventricular tachycardia (V tach) -> HR> 120, starts in ventricles, 

  • Caused: ischemic heart disease

What are the 3 causes of Edema? Please provided a short description

Heart Failure (HF)

• Poor pumping → RAAS activated → Na⁺ and fluid retention → increased blood volume

Liver Cirrhosis

• ↓ Plasma proteins → ↓ oncotic pressure (can’t hold fluid in vessels)

• Portal hypertension from blocked hepatic vessels → fluid backs up

Renal Disease

• Damaged basement membrane in nephrons → loss of plasma proteins in urine → ↓ oncotic pressure

Define

Glaucoma

increased intraocular pressure (IOP) -> IOP can damage the optic nerve

S/Sx of dec K+ (7)

muscle cramps

muscle weakness to paralysis 

hypotension

arrhythmias

polyuria

polydipsia

lightheaded → syncope

S/Sx of inc K+ (3)

Palpitations → chest pain 

SOA

N&V

Class

Action

Tx

Adverse effects

D2D

Ivabradine

Class → Hyperpolarization-Activated Cyclic Nucleotide-Gated Channel (HCN) Blockers

Action → SA node blocked in repolarization phase, thus dec HR, inc ventricles fill time ->  inc CO

Tx → chronic HF, age 6 months or older for stable HF, and decrease the risk of hospitalization

Adverse effects → bradycardia, HT, luminous phenomena

D2D → bradycardia with other negative chronotropic meds(beta blockers/meds slow HR)

Class

Action

Tx

Adverse effects

Contraindications

D2D

Digoxin

Class→ Cardiac Glycosides/ Pos inotropic

Action →  Pos inotrpic -> inc CO and dec HR

Tx → HF -atrial flutter - A-Fib

Adverse effects:

• HA, weakness, drowsiness

• yellow halo around objects (xanthopsia) / altered colored vision

• Digoxin toxicity: anorexia, N&V, malaise, irregular heart rhythm

Contraindications → Ventricular tachycardia/ fibrillation, acute MI

D2D:

• Increased toxicity- Erythromycin, tetracycline

• ​​Antacids will decrease absorption

What is the antiodte to dogxin toxcity?

Digoxin immune fab

Class

Action

Tx

Adverse effects

Contraindications

D2D

Entresto [valsartan and sacubitril]

Class → Angiotensin Receptor Neprilysin Inhibitor (ARNI)

Action:

• Blocks neprilysin ( lysis Na+) inc loss Na+Cl- and H2O

• block angiotensin II -> inhibit RAAS. -> dec BP and blood volume

Tx → Symptomatic HF, dec hospitalizations

Adverse effects → hypotension, hyperkalemia

Contraindications → Angioedema

D2D → ACE inhibitors and Sparing Diuretics cause hyperkalemia

Entresto [valsartan (ARBs) and sacubitril (Neprilysin inhibitor)]

Class

Action (3)

Tx

Adverse effects

Contraindications

Milrinone

Class →Cardiotonic/ Inotropic

Action:

• Blocks the enzyme phosphodiesterase

• Inc Ca2+ lvl -> stronger contraction

• prolong SNS stim -> inc HR

Tx:

• short term HF if no response to (digoxin, vasodilators, diuretics)

• Emergent situations

Adverse effects → ventricular arrhythmias, hypotension, thrombocytopenia.

Contraindications

• Acute MI 

• Hypovolemia

Class

Action

Tx (3)

Adverse effects

D2D

Hydrochlorothiazide

Class → Thiazide/Thiazide-like diuretics

Action → xcretion of sodium chloride (NaCl) along with some potassium (K⁺) and bicarbonate (NaHCO₃).

Tx → essential HNT -Edema -Glaucoma

Adverse effects:

• GI upset (fluid/electrolyte imbalance)

• hypotension

• Hypokalemia (muscle cramps, weakness) 

• Alkaline urine -> increases the chance of UTIs

D2D

• Digoxin toxicity- due to change K+ levels - Watch blood K levels

• Decrease the effect of antidiabetic agents

Class

Action

Tx

Adverse effects

Contraindications

D2D

Furosemide

Class → Loop diuretics (strong asf)

Action

• block chloride pump ascending loop of Henle, thus dec Na+Cl- reabsorption

Tx → acute HF, pulmonary edema, severe edema, HT

Adverse effects

• Hypokalemia

• Hypotension (dizziness) 

• hyperglycemia

Contraindications → anuria , diabetes and gout

D2D → decrease anti-HT with salicylates/NSAIDs

Class

Action

Tx (4)

Adverse effects

Contraindications

D2D

Acetazolamide

Class → Carbonic Anhydrase Inhibitors

Action → block carbonic anhydrase , inc H+ thus dec Na+ and HCO3 .

Tx → HNT - Edema - Glaucoma - HF

Adverse effects

• acid-base imbalance results (metabolic acidosis)

• hypotension, confusion, paresthesias

Contraindications

• fluid and electrolyte imbalance

• COPD

D2D

• Watch with aspirin (ASA) -> Salicylate toxicity (metabolic acidosis)

• Watch with K lowering agents

Class

Action

Tx

Adverse effects

Contraindications

D2D

Spironolactone

Class → Potassium Sparing

Action → aldosterone antagonist and blocks androgen production

Tx → hyperaldosteronism (inc Na+ and H20 retention, loss K+)

Adverse effects→ Hyperkalemia (SOA, chest pain, N&V, ataxia), 

Contraindications→ anuria

D2D

• Used in conjunction with/ Digoxin and Antiarrhythmic drugs for patients who are at risk of hypokalemia (increase the retention of K+) 

• decreased diuretic effect with salicylates

• hypotension with other antiHT

Class

Action (2)

Tx

Adverse effects

Contraindications

Mannitol

Class → Osmotic Diuretics

Action

• Pulls large amounts of fluid into urine by the osmotic pull of large sugar molecules

• Fluid is pulled into the vascular system from extravascular spaces, thus decreasing IOP

Tx → glaucoma, ICP(inner cranial pressure), trauma, drug OD

Adverse effects

• The increased fluid leads to HF, pulmonary edema

• decrease fluid hypotension, dehydration, dizziness, HA

Contraindications

• Auria and renal disease