logging in or signing up Chronic Heart Failure pattersonby Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 2646 Category: Education License: All Rights Reserved Like it (1) Dislike it (0) Added: September 26, 2008 This Presentation is Public Favorites: 2 Presentation Description No description available. Comments Posting comment... By: foryouo (11 month(s) ago) dksldksfjskdfjla sda a aa Saving..... Post Reply Close Saving..... Edit Comment Close By: quttiba (17 month(s) ago) Today I learnt something new! I like it so much, i love the voice. greetings from Mexico Saving..... Post Reply Close Saving..... Edit Comment Close By: quttiba (17 month(s) ago) good Saving..... Post Reply Close Saving..... Edit Comment Close By: saiajith (43 month(s) ago) Saving..... Post Reply Close Saving..... Edit Comment Close By: Lovecraft_jp (44 month(s) ago) Today I learnt something new! I like it so much, i love the voice. greetings from Mexico Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Congestive (chronic) Heart Failure: Brooke Y. Patterson, PharmD, BCPS Congestive (chronic) Heart FailureIntroduction: Introduction 5 million Americans have heart failure 550,000 new cases per year Affects nearly 10% of individuals over the age of 75 Most common hospital discharge for patients over 65 years oldOverview: Overview CHF is used to describe a condition in which the heart is incapable of maintaining adequate CO LV systolic dysfunction Acute vs. chronic Mainstay of therapy Alter RAAS, SNS, natriuretic peptide system, vasopressin, endothelin, and cytokinesPathophysiology: Pathophysiology Impaired ability of the heart to contract or relax Compensatory mechanisms Tachycardia and increased contractility Increased preload Vasoconstriction Ventricular hypertrophy and remodelingEtiology: Etiology MI Cardiomyopathies Ventricular hypertrophy Uncontrolled HTN Volume overloadStages of Heart Failure: Stages of Heart FailureNYHA Functional Classification of CHF: NYHA Functional Classification of CHFGeneral Principles: General Principles Correct underlying cause Systemic factors (thyroid, infection, etc.) Lifestyle modifications Review of medication regimen Discontinue drugs that may contribute to HF Pharmacologic therapyGoals of Therapy: Goals of Therapy Prolong survival Prevent disease progression Reduce hospitalizations Reduce symptoms Improve quality of lifePharmacology: PharmacologyDiuretics: Diuretics Loop diuretics Symptomatic treatment ONLY Impact on long-term outcomes not established Negative effects of long-term use Neurohormonal activation Diuretic tolerance Electrolyte imbalance Hypotension Renal dysfunctionAce Inhibitors: Ace Inhibitors Mainstay of treatment Prevention of HF in high-risk patients All patients with HF and reduced EF should receive ACE inhibitors unless contraindicated No preferred ACE inhibitorACE Inhibitors: ACE Inhibitors Benefits Decreased mortality Decreased symptoms Decreased hospitalizations Dosing considerations Start low and increase dose every 1-4 weeks to goal Avoid abrupt discontinuation Target dose is middle dose in dosing rangeAngiotensin-Receptor Blockers: Angiotensin-Receptor Blockers Reasonable alternative for patients who cannot take ACE inhibitors Consider adding ARB to patients who are symptomatic with reduced LVEF and currently on an ACE inhibitor ControversialBeta-Blocking Agents: Beta-Blocking Agents Not all beta-blockers were created equal! Carvedilol Metoprolol XL Recommended for stable patients with HF and reduced LVEF Initiate at low doseBeta-Blockers: Beta-Blockers Benefits (when added to ACEI) Decreased mortality Decreased hospitalizations Symptom improvement Dosing considerations Added to existing ACEI therapy (low-dose) when symptoms are stable Start low, double dose every 2-4 weeks to goal Avoid abrupt discontinuationAldosterone Antagonists: Aldosterone Antagonists Spironolactone vs. eplerenone Generic available Affinity for aldosterone receptor Initiate in patients with severe HF despite standard therapy Do not use with ACE and ARB combinedAldosterone Antagonists: Aldosterone Antagonists Benefits Decreased mortality Decreased hospitalizations For patients with Class III and IV heart failure Do NOT use with ACE inhibitor and ARB Dosing considerations Spironolactone 12.5-25mg QDDigoxin: Digoxin Benefits Improved symptoms No effect on mortality Used in symptomatic patients despite optimal ACE inhibitor, BB, spironolactone, and/or diuretic therapy Dosing considerations Serum digoxin levels of 0.5-1.0 ng/dL High risk of toxicity in elderly For most patients, 0.125mg PO QD is adequateIsosorbide & Hydralazine: Isosorbide and Hydralazine Mortality data specific for African-Americans with NYHA Class III-IV HF Currently receiving SOC Cannot tolerate ACE or ARBs HA and dizziness are common and dose-limitingAdjunctive Therapy: Adjunctive Therapy Anticoagulation NO routine use of warfarin Patients with HF who have previous thromboembolic event Antiarrhythmic Drugs Several drugs have increased mortality Amiodarone and dofetilide proven safeLifestyle Modifications: Lifestyle Modifications Self-monitoring of weight (daily) Drug adherence Low-sodium/DASH diet Exercise Smoking cessation EtOH abstinence Immunizations Influenza PenumovaxCase: Case SD is a 71 yo AAF with a PMH signification for s/p MI (1999), HTN, and CKD. Her most recent calc CrCl is 45 mL/min. Her current meds include metoprolol 50mg BID, ASA 81 mg QD, and lisinopril 2.5mg QD. Her BP is 135/88 mmHG. She has some dyspnea on exertion. PE is unremarkable. LVEF 33%. You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Chronic Heart Failure pattersonby Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 2646 Category: Education License: All Rights Reserved Like it (1) Dislike it (0) Added: September 26, 2008 This Presentation is Public Favorites: 2 Presentation Description No description available. Comments Posting comment... By: foryouo (11 month(s) ago) dksldksfjskdfjla sda a aa Saving..... Post Reply Close Saving..... Edit Comment Close By: quttiba (17 month(s) ago) Today I learnt something new! I like it so much, i love the voice. greetings from Mexico Saving..... Post Reply Close Saving..... Edit Comment Close By: quttiba (17 month(s) ago) good Saving..... Post Reply Close Saving..... Edit Comment Close By: saiajith (43 month(s) ago) Saving..... Post Reply Close Saving..... Edit Comment Close By: Lovecraft_jp (44 month(s) ago) Today I learnt something new! I like it so much, i love the voice. greetings from Mexico Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Congestive (chronic) Heart Failure: Brooke Y. Patterson, PharmD, BCPS Congestive (chronic) Heart FailureIntroduction: Introduction 5 million Americans have heart failure 550,000 new cases per year Affects nearly 10% of individuals over the age of 75 Most common hospital discharge for patients over 65 years oldOverview: Overview CHF is used to describe a condition in which the heart is incapable of maintaining adequate CO LV systolic dysfunction Acute vs. chronic Mainstay of therapy Alter RAAS, SNS, natriuretic peptide system, vasopressin, endothelin, and cytokinesPathophysiology: Pathophysiology Impaired ability of the heart to contract or relax Compensatory mechanisms Tachycardia and increased contractility Increased preload Vasoconstriction Ventricular hypertrophy and remodelingEtiology: Etiology MI Cardiomyopathies Ventricular hypertrophy Uncontrolled HTN Volume overloadStages of Heart Failure: Stages of Heart FailureNYHA Functional Classification of CHF: NYHA Functional Classification of CHFGeneral Principles: General Principles Correct underlying cause Systemic factors (thyroid, infection, etc.) Lifestyle modifications Review of medication regimen Discontinue drugs that may contribute to HF Pharmacologic therapyGoals of Therapy: Goals of Therapy Prolong survival Prevent disease progression Reduce hospitalizations Reduce symptoms Improve quality of lifePharmacology: PharmacologyDiuretics: Diuretics Loop diuretics Symptomatic treatment ONLY Impact on long-term outcomes not established Negative effects of long-term use Neurohormonal activation Diuretic tolerance Electrolyte imbalance Hypotension Renal dysfunctionAce Inhibitors: Ace Inhibitors Mainstay of treatment Prevention of HF in high-risk patients All patients with HF and reduced EF should receive ACE inhibitors unless contraindicated No preferred ACE inhibitorACE Inhibitors: ACE Inhibitors Benefits Decreased mortality Decreased symptoms Decreased hospitalizations Dosing considerations Start low and increase dose every 1-4 weeks to goal Avoid abrupt discontinuation Target dose is middle dose in dosing rangeAngiotensin-Receptor Blockers: Angiotensin-Receptor Blockers Reasonable alternative for patients who cannot take ACE inhibitors Consider adding ARB to patients who are symptomatic with reduced LVEF and currently on an ACE inhibitor ControversialBeta-Blocking Agents: Beta-Blocking Agents Not all beta-blockers were created equal! Carvedilol Metoprolol XL Recommended for stable patients with HF and reduced LVEF Initiate at low doseBeta-Blockers: Beta-Blockers Benefits (when added to ACEI) Decreased mortality Decreased hospitalizations Symptom improvement Dosing considerations Added to existing ACEI therapy (low-dose) when symptoms are stable Start low, double dose every 2-4 weeks to goal Avoid abrupt discontinuationAldosterone Antagonists: Aldosterone Antagonists Spironolactone vs. eplerenone Generic available Affinity for aldosterone receptor Initiate in patients with severe HF despite standard therapy Do not use with ACE and ARB combinedAldosterone Antagonists: Aldosterone Antagonists Benefits Decreased mortality Decreased hospitalizations For patients with Class III and IV heart failure Do NOT use with ACE inhibitor and ARB Dosing considerations Spironolactone 12.5-25mg QDDigoxin: Digoxin Benefits Improved symptoms No effect on mortality Used in symptomatic patients despite optimal ACE inhibitor, BB, spironolactone, and/or diuretic therapy Dosing considerations Serum digoxin levels of 0.5-1.0 ng/dL High risk of toxicity in elderly For most patients, 0.125mg PO QD is adequateIsosorbide & Hydralazine: Isosorbide and Hydralazine Mortality data specific for African-Americans with NYHA Class III-IV HF Currently receiving SOC Cannot tolerate ACE or ARBs HA and dizziness are common and dose-limitingAdjunctive Therapy: Adjunctive Therapy Anticoagulation NO routine use of warfarin Patients with HF who have previous thromboembolic event Antiarrhythmic Drugs Several drugs have increased mortality Amiodarone and dofetilide proven safeLifestyle Modifications: Lifestyle Modifications Self-monitoring of weight (daily) Drug adherence Low-sodium/DASH diet Exercise Smoking cessation EtOH abstinence Immunizations Influenza PenumovaxCase: Case SD is a 71 yo AAF with a PMH signification for s/p MI (1999), HTN, and CKD. Her most recent calc CrCl is 45 mL/min. Her current meds include metoprolol 50mg BID, ASA 81 mg QD, and lisinopril 2.5mg QD. Her BP is 135/88 mmHG. She has some dyspnea on exertion. PE is unremarkable. LVEF 33%.