A patient with structural Heart disease but without signs and symptoms is in stage:

A patient with structural Heart disease but prior or current signs and symptoms is in stage:

A patient with refractory HF requiring specialized interventions:

LVEF < 40&%

LVEF 40-49%

LVEF > 50&

Diuretics, MRA, digoxin are used to:

Digoxin and blockers are used to:

ACEIs, BB, hydralazine, and isosorbide dinitrate are used to:

ARB, MRA, diuretics, sacubitril/valsartan, ivabradine, and digoxinare used to:

ACEIs, ARB, MRA, BB, sacubitril/valsartan, ivabradine are used to:

(Stage)

Goals:

1. Heart-healthy lifestyle

2. Prevent vascular, and coronary disease

3. Prevent LV structural abnormalities

Drugs: ACEI, ARBs, Statins

(Stage)

Goals:

1. Prevent HF symtoms

3. Prevent further cardiac remodeling

Drugs: ACEI, ARBs, BB

(Stage)

Goals:

1. Control symptoms

2. Improve HRQOL

3. Prevent hospitalization

4. Prevent mortality

Treatment: Diuresis, Revascularization or valvular surgery

(Stage)

Goals:

1. Control symptoms

2. Patient education

3. Prevent hospitalization

4. Prevent mortality

Treatment: Diuresis, ACEIs, ARBs, BB, Aldosterone antagonist, Revascularization or valvular surgery, ICD, and CRT

(Stage)

Goals:

1. Control symptoms

2. Improve HRQOL

3. Prevent hospitalization

4. Establush patient's end-of life goals

Treatment: heart transplant, chronic inotropes, MCS, surgery, Palliative care

NYHA class II-IV

CrCl > 30 & K < 5

NYHA class II-III

Adequate BP on ACEI or ARB. No C/I to ARB or sacubritril

NYHA class III-IV in black patients

NYHA class II-III LVEF < 35% >40 post MI

MAO: (-) SLC12A3 in the distal convoluted tubule -> (-) Na/H2O reabsorption in the nephron = vasodilation

MAO: competitive (-) NKCC2 in the thick ascending limb of the loop of Henle -> (-) H2O reabsorption, ⬆ excretion

Side effects: tinnitus, reversible or permanent hearing loss, or reversible deafness.

MAO: Competitive antagonist of aldosterone at the convoluted renal tubule -> ⬆ Na/water excretion, ⬆K retention.

Binds to mineralcorticoid receptor -> (-)Na+/K+-ATPase -> (-) Na+ K+ transport in the distal tubule.

It also has anti-androgenic activity. Progesterone agonist.

⬆ the hypotensive activities of ACEI & ARB

Acute overdosage may be manifested by drowsiness, mental confusion, maculopapular or erythematous rash, nausea, vomiting, dizziness, or diarrhea. Also has been shown to be tumorigenic in chronic toxicity studies in rats.

MAO: ⬆ plasma osmolality -> ⬆ shift of water from brain and tissues to interstitial fluid and plasma

Adverse effects: nephrotoxic.

MAO: (-) carbonic anhydrase -> ⬇ CO2 tension in the pulmonary alveoli -> ⬆ arterial O2.

⬇ availability of hydrogen ions for active transport in the renal tubule lumen.

Toxicity: hepatoxicity, rash, fever, eosinophilia, and Steven Johnson Syndrome

MAO: Antagonist of V1A/V2A -> ⬆ excretion of water (aquaresis)

MOA: (-) Na-K- ATPase membrane pump -> ⬆Na/Ca -> contractility

Also acts on the electrical activity of the heart, ⬆ the slope of phase 4 depolarization, ⬇ the AP duration, and ⬇ the maximal diastolic potential.

Toxicity includes ventricular tachycardia or ventricular fibrillation, or progressive bradyarrhythmias, or heart block, Blurred vision, yellow, green or blue chromatopsia (enhanced color intensity).

Beta blockers: May increase the bradycardic activities of this drug.

MAO: Active form LBQ657 -> (-) neprilysin -> ⬇ breakdown and ⬆ NP, ⬆ vasocontrictio by ⬆ AT2.

+ Vasaltan = (-) AT2 -> ⬇ resistance and BP

MAO: Recombinant form of BNP -> ⬆ cGMP -> Smooth muscle relaxation.

Prazosin, terazosin and Doxazosin acts in vasculature by ⬇ vasoconstriction.

Clonidine stimulate CNS alpha receptors -> vasodilation

Lisonopril, Captopril and Enalapril, (-) AT1 to At2 conversion -> ⬇ vasoconstriction and ⬇fluid retention.

Losartan, Valsartan and Candesartan Binds to AT2R-> block AT2 -> ⬇ vasoconstriction and ⬇ fluid retention.

Propranolol, Metoprolol and Nebivolol in the heart -> ⬇ contractility, ⬇ HR and ⬇ CO.

In the CNS -> block sympathetic

Amlodipine, Nifedipine, Nicardine block Ca influx -> vasodilation

Verapamil and Diltiazem vasodilation in sm and block Ca in myocytes and SA cells -> vasodilation, ⬇ HR and ⬇ contractility.