Heart Failure Meds and Anticoagulants

Heart Failure Medications and Anticoagulants

Brent Evans, MSN, RN, CNE

Heart Failure Overview

• Definition: Inability of heart to meet circulatory needs.

  • Compensatory mechanisms increase cardiac output (CO).

  • Over time, weakened heart is unable to maintain CO.

  • Compensation can exacerbate heart failure (HF).

  • Fluid backs up, leading to decreased oxygenation of tissues.

  • Decreased quality of heart pump results in tachycardia, further decreasing CO and increasing myocardial oxygen demand.

Causes of Heart Failure

• Coronary Artery Disease: Most common cause, often leading to myocardial infraction (MI).

• Hypertension: Contributes significantly to HF.

• Valvular Disease: Affects heart function.

• Cardiomyopathy: Disease of heart muscle leading to heart failure.

Signs and Symptoms of Heart Failure

Left-Sided Heart Failure

• Orthopnea: Difficulty breathing when lying flat.

• Anxiety: Secondary to shortness of breath (SHOB).

• Tachycardia: Increased heart rate to compensate.

• Weak Pulses: Indicating decreased cardiac output.

• Cough: Fluid backing up into lungs.

Right-Sided Heart Failure

• Jugular Venous Distension (JVD): Observed when not lying flat.

• Hepatomegaly: Liver enlargement due to fluid back-up.

• Edema: Fluid retention in body tissues.

• Nocturia: Increased urination at night due to fluid dynamics.

• Exertional Dyspnea: Shortness of breath on exertion.

Drug Treatment for Heart Failure

• Primary goal: Reduce workload on heart and/or improve heart's ability to increase output.

Drug Classes

• Beta Blockers:

  • Reduce heart rate and force of contractions.

  • Examples: Metoprolol, Atenolol, Propranolol.

  • Block beta-1 receptors, leading to decreased heart workload.

  • Monitor heart rate (HR) and blood pressure (BP) before administration.

• ACE Inhibitors:

  • Examples: Lisinopril, Captopril.

  • Block angiotensin II to reduce afterload and decrease cardiac remodeling.

  • Monitor BP before administration.

• Diuretics:

  • Reduce fluid overload and improve symptoms (covered separately).

• Digoxin:

  • Cardiac glycoside that increases force of contraction (positive inotrope) and decreases heart rate (negative chronotrope).

  • Parameters: Check apical pulse for 60 seconds before administration.

  • Narrow therapeutic range (0.5-0.8 ng/mL).

  • Monitor for toxicity: dysrhythmias, nausea, visual disturbances, etc.

Newer Medications

• Dobutamine: A beta-1 agonist, improving cardiac output and lowering BP.

• Milrinone: A phosphodiesterase inhibitor, enhancing cardiac function and decreasing afterload.

• Ivabradine: An HCN blocker that lowers heart rate without affecting contractility.

• SGLT2 Inhibitors (e.g., Dapagliflozin): Promote fluid and sugar excretion.

Assessing Heart Failure Drug Therapy

• Monitor:

  • Heart Rate (HR) and Blood Pressure (BP)

  • Level of consciousness (LOC)

  • Exertion tolerance

  • Urine output (UOP)

  • Capillary refill and peripheral pulses

  • Lung sounds and daily weights

  • Electrolytes and Brain Natriuretic Peptide (BNP) levels

  • Improved functional status.

Anticoagulants Overview

• Antiplatelets:

  • Examples: Aspirin, Clopidogrel (Plavix).

  • Stop platelets from aggregating; used primarily for arterial clots.

  • Often prescribed in dual therapy.

• Thrombolytics:

  • Examples: Urokinase, Alteplase.

  • Used to dissolve existing clots; high risk of bleeding.

• Anticoagulants:

  • Indicated for prevention of blood clots, e.g., in DVT, PE, atrial fibrillation.

  • Treatment involves parenteral drugs like heparin.

Heparin

• Administered subcutaneously or intravenously.

• Monitor Partial Thromboplastin Time (PTT), aiming for specific therapeutic ranges.

• Risk of complications, including bleeding and thrombocytopenia.

Low Molecular Weight Heparin (LMWH)

• Example: Enoxaparin (Lovenox).

• More expensive, longer half-life, and can be given at home post-surgery.

Warfarin

• Oral anticoagulant, requiring monitoring of INR (ideal range typically 2-3).

  • Many drug interactions, vitamin K is essential in management.

Newer Oral Anticoagulants

• Apixaban, Dabigatran have more rapid onset and less monitoring requirements.

Important Considerations

• Patient Monitoring:

  • Signs of active bleeding or upcoming invasive procedures are critical.

  • Contextualize anticoagulation therapy in relation to patient’s overall health and treatment plan.

Additional Resources

• Heart Failure readings: Pages 211-241 for background; pages 255-256 for nursing process; pages 265-271 for digoxin and nitrates; pages 288-302 for anticoagulants.

Questions?