28 Chronic HF

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• systolic: drugs improve mortality

• diastolic: no specific therapy, no real treatment

Systolic

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• all the results bad for a weak heart (chronic systolic HF)

• good for chronic not acute

• A-BEAM spotlight on heart: the beta-1 selective antagonists primarily suppress adrenergic stimulation of the heart (cardioselective)

• Broken heart strings under A-BEAM spotlight: cardioselective beta blockers are useful in the acute treatment of MI and other acute coronary syndromes (ACS)

• Failing heart balloon in the A-BEAM spotlight: cardioselective beta blockers are useful in the management of chronic heart failure

• Extinguished alpha candle on CARVED candleholder: carvedilol is a nonselective beta blocker and alpha-1 blocker

• CARVED candleholder next to failing heart: carvedilol (in addition to cardioselective beta blockers) is useful in the management of chronic heart failure.

• Angel: beta blockers (e.g. carvedilol and cardioselective agents) reduce mortality in chronic heart failure and post-MI

• Remodeling: beta blockers reduce cardiac remodeling by protecting the heart from excess circulating catecholamines

• Failing heart balloon: K+ diuretics (e.g. spironolactone, eplerenone) are useful in the treatment of heart failure

• Remodeling: mineralocorticoid antagonists (e.g. spironolactone, eplerenone) prevent myocardial remodeling induced by high levels of aldosterone

• Angel: mineralocorticoid antagonists (e.g. spironolactone, eplerenone) decrease mortality in heart fail

• Lids on chest: spironolactone can cause gynecomastia

• Droopy churro: spironolactone can cause impotence and decreased libido

• eplerenone better for men

• feared SE: angioedema

• higher HR: heart work harder

• for pts on max dose BB

• low EF: high annual risk of SCD

• monitors heart rhythm, shocks heart when detect dangerous rhythm

• left: LV and RV asynchronized contraction, BBB

• very different from slow heart pacemaker