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What is the most useful way of evaluating CCF?
What are the most common symptoms?
What are some causes of CCF?
-shortness of breath, edema and fatigue.
-Coronary artery disease (CAD), Hypertension, Diabetes, Mitral valve disease and Chronic alcohol.
What are some treatments for Systolic Heart failure?
What is a treatment for acute heart failure?
- ACE Inhibitors
- Beta blockers
- Cardiac glycosides - digoxin
What will Ace inhibitors do?
ACE inhibitors improve exercise tolerance and left ventricular ejection fraction. It decreases mortality and morbidity due to CCF.
-decrease preload, afterload, aldosterone production and inhibit cariac and vascular remodeling
What are the side effects of ACE inhibitors?
- -Dry irritating persistent cough (due to increased Bradykinin)
- -Fetal toxicity
What can be used in patients who cannot tolerate ACE inhibitors?
What are some other vasodilators that can be used in CCF?
- -Isosorbide dinitrate and hydralazine
- -Amlodipine and prazosin are other vasodilators and can be used in CCF
When are Diuretics for Relief of Symptoms used?
What diuretics are the most effective?
- Useful in reducing the symptoms of volume overload by:
- -decreasing the extra cellular volume
- -decreasing the venous return
- -The loop diuretics are the most effective
- -Thiazides are effective in mild cases only.
What can be added to Diuretics to modestly enhance the diuresis; more importantly, prevent cardiac remodeling and thus improve survival??
- K sparing diuretics
- -Spironolactone and Eplernone
What is Nesiritide??
What are its effects?
It is a synthetic BNP (and a Arterial and venous dilator)
-It increases CO by vasodilation without increasing HR or Oxygen consumption
used to treat acutely decompensated congestive heart failure with dyspnea at rest or with minimal exertion
What is the Beta blockers role in CCF?
- -Acts primarily by inhibiting the sympathetic nervous
- -Increases beta receptor sensitivity (up regulation).
- -Anti-arrhythmic properties.
- -Anti-oxidant properties.
What is the treatment regeme for Beta blockers in CCF?
Which ones are the best for CCF?
-Start at low dose and monitor for bradycardia
-Carvedilol and Metoprolol are the most commonly used for CCF amongst beta blockers
Name a cardiac Glycoside
What does it do?
When is it the DOC?
- -Inhibition of Na/K ATPase pump increase intracellular sodium concentration – eventually increase cytosolic calcium.
- -It restores the vagal tone and abolishes the
- sympathetic over activity.
-Increase the refractoriness of AV node
-->decreases ventricular response
to atrial rate.
-Digoxin is used as a first-line drug in patients with congestive heart failure who are in atrial fibrillation.
What are the Toxicities of Digoxin?
What are the three drugs that can increase its concentration?
- Gynecomastia, visual disturbances and psychosis
- -AV block and bradycardia
Amiodarone, Verapamil and Quinidine
What is Digoxins Toxicity enhanced by?
What can be given to treat life threatening digoxin overdose?
What is Digitoxin?
Enhanced by Hypokalemia and hypercalcemia
-Digoxin antibody (Digibind)
- Digitoxin is another cardiac glycoside and is similar to digoxin, but it has a LONGER half life and is eliminated via the liver. Can be used in patients with poor renal Function.
Name the Cardia Inotropes for Acute heart failure.
- 1. Phosphodiesterase III inhibitors
- -Milrinone (positive inotropic and vasodilator)
(a beta 1 agonist with increases contractility and CO) --- Does NOT increase HR.
What druges do you used in acute heart failure?
Drugs for Chronic Heart failure?
- Dobutamine (or dopamine)
- Ace inhibitors
- Renin inhibitors