Heart failure

Question 1

HErEF vs HEpEF

Answer 1

HErEF - reduced systolic function/ejection fraction
- problem with force of ventricular contraction –> reduced CO

HEpEF - preserved systolic function/ejection fraction
- ventricular contraction normal, filling during diastole impaired
- often due to ventricular walls thickening
- diastolic heart failure
- limited evidence for treatment

Question 2

how does the RAAS and SNS impact systolic heart failure

Answer 2

During SHF, CO is reduced, resulting in reduced blood pressure. This results in SNS and RAAS activation by the body to raise BP, this raise in BP increases pre-load on the heart, worsening heart failure by placing to much demand on the heart
- can also cause pulmonary oedema due to pulmonary capillaries taking on extra blood

Question 3

What is preload and afterload?

Answer 3

Preload - blood volume/pressure entering the R atria through the vena cava

Afterload - blood volume/pressure leaving the heart through the aorta to the systemic circulation

Question 4

How do we treat systolic HF

Answer 4

Treatment slows progression of HF

• anithypertensive - ARB or ACEI (can also replace with ARNI (sacubitril (neprilysin inhbitor) + valsartan)
• aldosterone antagonists - spironolactone (MONITOR FOR HYPRKALAEMIA)
• BB
• SGT2I

Question 5

non- pharmacological management of HF

Answer 5

weight loss if obese
avoid smoking
reduce sodium intake
fluid resitrictions
daily weighs
aerobic exercise
vaccinations up to date

Question 6

BB counselling points

Answer 6

Always tell patients about fatigue and dizziness (often leads to poor adherence)
- tell patients not to drive or operate machinery if affected
- inform of risk vs benefit
- advise patients that these adverse effects with subside
- inform to not stop medications suddenly as this will cause rebound effect