heart failure

Question 1

what are the 3 types of heart failure and what is the most common

Answer 1

• left side failure - due to hypertension (commonest)
• right side failure - chronic lung disease
• bi-ventricular failure - left ventricular cause pulmonary congestion which lead to right sided failure

Question 2

describe the 4 classes of heart failure symptoms

Answer 2

Class 1 - no symptoms during normal activity
Class 2 - comfortable at rest, normal activity
triggers symptoms
Class 3 - comfortable at rest, minor activity
trigger symptoms
Class 4 - unable to carry out any physical activity
as well as symptoms at rest

Question 3

symptoms of heart failure

Answer 3

hypotension (tiredness,dizziness), reduced urine flow, cold peripheries, breathlessness, oedema, atrial fibrillation

Question 4

Causes of left side heart failure (1) S_ D_

Answer 4

• Systolic dysfunction
  = impaired contractility (myocardial infraction, overstretched heart, leaky valves, mitral/aortic regurgitation)
  = pressure overload (uncontrolled hypeetension)

Question 5

Causes of left side heart failure (2) D_ D_

Answer 5

Diastolic dysfunction
=reduced compliance of ventricular wall
- left ventricular hypertrophy, myocardial ischaemic

Question 6

Cause of left side heart failure (3) O_ L_ V_ F_

Answer 6

Obstruction of left ventricular filling
= cardiac tamponade
= narrowed mitral value - mitral stenosis

Question 7

what is used to identify heart failure

Answer 7

echocardiogram
= reduced ejection fraction
= <40%
= stroke volume is reduced, reduced exercise tolerance

Question 8

treatment (pharamceutical) for heart failure

Answer 8

-beta blocker
-vasodilator
-venodilators
-ACE inhibitor
-K+ sparing diuretics (spironolactone)
-Digoxin
Not need to know
-loop diuretics
-angiotensin receptor
-hyperpolarisation activated cyclic nucleotide-gated channel block
-loop diuretics

Question 9

name a loop diuretics, and the mechanism of action

Answer 9

Furosemide
-increase vasodilator
-promotes urinary excretion of Na+/Cl-, K+, H20
-reduces electrolyte reabsorption in ascending limb
excretion of 20-25% of filtered Na+

Question 10

adverse effects of loop diuretics

Answer 10

dizziness, electrolyte imbalence, fatigue, headache, metabolic alkealosis, muscle spasms, nausea
risk of urinary retention
risk of hypovoleamia, hypotension

Question 11

when are loop diuretics prescribed

Answer 11

• pulmonary oedema due to acute left ventricular failure
• chronic heart failure

Question 12

contra-indications of loop diuretics

Answer 12

=anuria, drug-induced renal failure, severe hypokalaemia, severe hyponatreamia
=use lower dose in elderly

Question 13

what type of administration route for loop diuretics can relief of breathlessness and reduce pre-load sooner then onset of diuresis

Answer 13

Intravenous

Question 14

Give the drug name of nitrate+vasodilators

Answer 14

Hydralazine with nitrate

Question 15

how does Hydralazine with nitrate

Answer 15

nitrates= relaxes veins (ease work on the heart)
Hydralazine = dilates arteries (lowers BP)
reduces preload and risk of pulmonary congestion, reduce after load and increase stroke volume

Question 16

Hydralazine+nitrates adverse effects

Answer 16

-fainting, fast/pounding heart, rash, swollen joint, fever, numbness + tingling in peripheries
-Blurred vision, chest pain, hives, difficult in breathing, nausue and vomiting
-Tachycardia

Question 17

if taking Hydralazine+nitrate you cant consume

Answer 17

Cant take alcohol, cough/cold medicine, black liquorice, herbal/chinese medicine, anti-inflammatory medicine, viagra

Question 18

When are hydralazine+nitrate prescibed

Answer 18

if patients cant take ACE inhibitors and ARBs
if a person has black heritage

Question 19

what is the mechanism of digoxin

Answer 19

positive inotrope which increases intracellular Ca2+, interupts Na2+ extrusion and blocks Na+/K+ pump

Question 20

why would digoxin be prescribed

Answer 20

-supraventricular arrhythmias
-chronic atrial firbrilation
-chronic heart failure = improves symptoms but not mortality

Question 21

Digoxin’s adverse effects

Answer 21

arrhythmias, cardiac conduction problems, cerebral impairment, diarrhoea, dizziness, nausae/vomitting, skin reaction, vision disorders

Question 22

what are the risks of using digoxin

Answer 22

digitalis toxicity with electrolyte imbalance

Question 23

what is given for heart failure with reduced cardiac function

Answer 23

ACE inhibitor plus beta blockers

Question 24

Name the two diuretics used to treat heart failure and how they differ

Answer 24

Loop diuretics -furosemide
K+ sparing - spironolactone
Spironolactone doesn’t cause hypokalaemia

Question 25

spironolactone is a what

Answer 25

mineralocorticoid receptor antagonists