Heart Failure (med) 2

Heart Failure (med) 2

1. Management

   • General principals
     • Revese any causes
     • Non-pharmacologic
     • Education
     • Pharmacologic
       • Tx
         • Angiotension converting enzyme inhibitors
           • Reduce BP
         • Beta-Blockers
           • Reduce contractile force
         • Procorolan
           • reducing the heart rate via specific inhibition of the pacemaker current
         • Angiotensin Receptor Blockers
           • reduce BP inhibit binding of angiotensin II
         • Aldosterone antagonists
           • a diuretic drug
             • inhibit reabsorbtion sodium in collecting duct
               • Congested syndrome
               • Elevated filling pressure
               • Leg/Abdominal Swelling
         • Hydralazine and oral Nitrates
           • smooth muscle relaxant and acts as a vasodilator
         • Diuretics
         • Digoxin
           • (Na+/K+ ATPase) inhibitor
             • increase in the intracellular calcium concentration
               • +++ contractility
         • Nephrilysin inhibition
           • increases the levels of natriuretic peptides, bradykinin, and adrenomedullin
             • countering vasoconstriction, sodium retention, and maladaptive remodeling
         • Anticoagulants and antiplatelets
           • Clopidogrel
           • Ticagrelor
             • P2Y12
           • Prasugrel
           • Aspirin
         • Antiarrhythmic Agents
     • Device therapy
       • LVEF<35%
         • not within 40day of MI
         • NYHA 2-3
       • Bi-ventricular pacing
       • Cardiac Arrest survivor
         • VT
         • V-Fib
         • no MI
           • 48hr post MI + no recurrent ischaemic event
     • Cardiac Resync theraphy
       • Bi-ventricular Pacing
         • Sinus rhythm
         • Wide QRS >130ms
         • Severe LV systolic dysfunction
           • <35% EF LV dilatation
     • PCI/Surg
     • Transplant
   • Goals
     • Relieve HF symptoms
       • improve overall clinical status
       • stablize px
     • Reduce morbidity+mortality
       • Slow/Reverse disease
       • Identify causes LV dysfunction

2. Complcation

   • Symptoms
     • Impaired exercise tolerance
     • deconditioning
   • Arrhythmia
     • A-fib
     • Ven ttachycardia
     • V-Fib
   • Hypoperfusion Efx
     • Cardiogenic shock
     • Renal insufficiency
     • Blood stasis
       • Thromboembolic disease
   • Deterioration
     • Decompensated heart failure
     • Pump failure-death

3. Drugs CI

   • Worsen CCF
     • CCB
     • NSAIDS
       • Coxibs
     • Doxasozin
     • Anti-arrhythmatics
     • Cold Cures
     • Thiazolidienediones
     • Anti TNF
       • in Rhumatoid Arthritis
     • ChemoTx
       • Herceptin
       • Doxorubicin
       • Cyclophosphomide

4. HFPEF Dx

   • S&S CHF
   • Normal LVEF
   • Measurement of diastolic parameters
     • exclude valve dysfunction
   • Naturectic peptide
   • Tx
     • treat like low LVEF
     • Control RF
       • Hypertension
       • Tachycardia
       • Fluid retention
       • Myocardial ischaemia

5. Acute HF management

   • Initial
     • Sit up Px
     • 60-100% O2 if no COPD
     • tx unstable arrhythmias
     • Morphine iv
       • Watch ABG
         • resp depression
     • Furosemide
       • loop dieuretics
     • Sublingual GTN spray
   • After ABC (airway, Breathing, Circulation)
     • Distress Pain
       • anagesia
       • morphine
     • Pulmonary congestion
       • DIuretics
       • Nitrates
     • Arrhythmia
       • Antiarthythmiatics
       • Pacing
       • DCCV
     • SpO2<95/90% in COPD
       • 100% O2
       • CPAP
       • Menchanical ventilation
     • Hypotensive
       • invasive monitoring
       • Ionotropes
       • IABP
   • Observation
     • Urinary catheter assess diuresis response
     • Repeat ABG
     • GTN iv if Bp allows
     • no response
       • ICU + CPAP
   • Symptomatic Management
     • Diueretics
       • Reduce intravascular volume
     • Vasodilator
       • improve diastolic filling
     • Digoxin
       • with natural (regular afib)
     • Mechanical interventions
       • PCI
       • CABG
       • CRT
       • LVAD
       • Transplant
   • Longterm
     • NeuroHormonal
       • ACE inhibitors / ARBs
       • B-Blockers
       • Procorolan
       • Aldosterone antagonist
       • Nephrilysin Inhibition
     • Mechanical intervention
       • CRT
       • LVAD

6. Complex Px

   • LV dysfunction
     • persistent symptoms
   • Renal dysfunction
   • Hypotension
   • Metabolic derangements
   • Severe
     • Hypo
     • Hyper
   • X admissions
   • Side effects
   • HFPEF
   • VAD or Transplantation