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Cardiology > Management of Heart Failure > Flashcards

Management of Heart Failure Flashcards

1
Q

Chronic causes of CHF

A

Chronic Degenerative Valve Disease (CDVD)
Dilated cardiomyopathy
Restrivtive/hypertrophic cardiomyopathy

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2
Q

How does CDVD result in CHF?

A

Regurgitation of valve means less forward flow into aorta
Less blood getting into circulation
LA dilates and pressure increases
LA backs up into pulmonary vein resulting in pulmonary oedema

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3
Q

How does DCM result in CHF?

A

Forward flow calls due to poor contractility
All chambers enlarged and thin alls
Blood backs up into LA the PV

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4
Q

How does HCM result in CHF?

A

Forward failure due to failure to fill ventricle (diastolic failure)

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5
Q

What are the considerations before managing heart failure?

A

Primary cause of heart disease
Non-specific treatment for disease
Treatment of heart failure
Any dysrhythmias
Complicating/co-exiting factors
Regular assessment
Owner expectations

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6
Q

What is more common, L or R CHF

A

LCHF - pulmonary oedema

RCHF is often secondary to pericardial effusion or R valve disease (IN DOGS)
Leads to degree of left sided disease

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7
Q

Typical Presentation of Heart Disease

A
  • Heart failure
    ○ Cough
    ○ Dyspnoea
  • Exercise intolerance
  • Collapse
  • Found incidentally at routine appointment
  • Non specific weight loss
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8
Q

Causes of Primary Heart disease

A

Mitral valve disease
Cardiomyopathy
Congenital issues
Pericardial issues
Metabolic issues
Deficiencies
Idiopathic

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9
Q

What is DCM?

A

Dilated cardiomyopathy
Result of contractility failure

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10
Q

What is the aim for treating DCM?

A

Improve contractility in order to improve cardiac output

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11
Q

Which drugs will increase contractility?

A

Positive inotropes

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12
Q

Examples of positive inotropes

A

Digoxin
Pimobendan
Dobutamine

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13
Q

What is pimobendan?

A

Positive inotrope (improves contractility)
Inodilator (decreases pulmonary vascular resistance)
Calcium-sensitising
PDE III inhibitor
Also has antithrombotic activity

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14
Q

What so PDE III inhibitors do?

A

Causes vasodilation to decrease systemic vascular resistance
Also increases oxygen supply to heart

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15
Q

What is an inodilator and why is it useful for heart failure?

A

Decreases pulmonary vascular resistance
Reduced risk of pulmonary oedema

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16
Q

DIgoxin

A

Positive inotope
Negative chronotrope (decreases HR)
Increases vagal tone (reduces SNS activity)
VERY NARROW THERAPEUTIC WINDOW
DON’T USE IN RENAL FAILURE

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17
Q

What is dobutamine?

A

Positive inotrope - increases contractility

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18
Q

Goal for HCM management

A

Need ventricles to relax to allow filling
(Diastolic failure)

19
Q

What treatment is used for HCM?

A

Positive lusitropes

DO NOT USE POSITIVE INOTROPE (Pimobendan)

20
Q

What are Positive lusitropes?

A

Help heart relax
Calcium channel blockers
* Diltiazem
* Verapamil
Beta blockers
* Atenolol
* Propranolol

21
Q

When can you treat HCM?

A

Once the cat is in heart failure
Can’t treat cats before

22
Q

What is diltiazem?

A

Positive lusitrope
May reduce LVH
Antidysrhythmic

23
Q

What are the overall goals of managing heart failure?

A

Reversing compensatory mechanisms
ontrol Salt & Water Retention
* Reduce Workload
○ Decrease afterload
○ Decrease physical activity and stress
* Improve Pump Function
○ (Improve systolic function)
○ (Improve diastolic function)
○ Reverse/modify myocardial remodeling

24
Q

Heart failure treatment in dogs

A

Endo or myocardial diseases leading to CHF are treated the same as the outcome is the same
* Diuretics
○ Furosemide
* Positive inotrope
○ Pimobendan
* ACE inhibitors
○ Glyceryl trinitrate
* Aldosterone antagonists
○ Spirinolactone

25
Q

What are the stages of heart disease

A

A
B1
B2
C
D

26
Q

Stage A

A

High risk of heart disease but no identifiable structural disorder of heart

27
Q

Stage B1

A

Murmur present
Asymptomatic with no radiographic or echocardiographic evidence of remodelling

28
Q

Stage B2

A

Murmur present
Asymptomatic with radiographic or echocardiographic evidence of left-sided heart enlargement

29
Q

Stage C

A

Past or current clinical signs of heart failure with associated structural heart disease

30
Q

Stage D

A

End-stage disease with clinical signs of heart failure that are refractory to standard therapy

31
Q

Stage B1 management

A

Weight control
Regular re-assessment
Client education
No medical treatment

32
Q

Stage B2 management

A

Weight control
Regular re-assessment
Client education
PIMOBENDAN

33
Q

Stage C management

A

1 - pimobendan
2 - ACE inhibitor
3 - diuretic
4 - aldosterone antagonist

Don’t always use all 4 - financial factors

34
Q

What are diuretics?

A

Reduce fluid accumulation in body
Act on kidneys to increase urine output
Can result in excretion of potassium (hypokalaemia)
Controls oedema formation

35
Q

Loop diuretic examples

A

Furosemide
Torasemide

36
Q

Potassium sparing diuretics

A

Spironolactone (Aldosterone antagonist )

37
Q

What is Furosemide

A

1st line diuretic VERY POTENT
SAVES LIVES
Monitor for azotemia and hypokalaemia

38
Q

What is spironolactone

A
  • Aldosterone antagonist
  • Potassium sparing effect
  • Beneficial effects in CHF
  • Improvements in cough, dyspnoea, syncope, mobility
39
Q

Common problems with diuretics

A

Volume depletion leads to potential hypovolaemia
Difficult in cats with HCM - They rely on preload
Stimulates RAAS
Can exacerbate azotaemia

40
Q

What are ACE inhibitors?

A

Venous dilators
Decrease preload
Reduce fluid build up
Arterial dilators
Reduce afterload
Increase output
Reduce valve leakage

Vasodilation and decreased salt/water retention

Will cause azotaemia and hypotension
Need to monitor renal parameters

41
Q

Example of ACI inhibitors

A

Glyceryl trinitrate (venous)
Hyralazinel (arterial)

42
Q

What is emergency CHF therapy?

A

Always start with furosemide
Oxygen therapy
Drain any pleural effusion/ascites/pericardial effusion

Pimobendan in dogs with DCM

Once stable start spironolactone
Consider antidysrhythmic
Wean off IV furosemide to oral

43
Q

Treatment for Feline THromboembolic disease

A

Clopidogrel - inhibits platelet aggregation
Aspirin - thins blood

Cardiology (18 decks)

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