Session 9 - Heart Failure

Question 1

Define heart failure

Answer 1

a state in which the heart fails to maintain an adequate circulation for the needs of the body despite an adequate filling pressure

Question 2

What is the primary cause of systolic heart failure?

Answer 2

IHD

Question 3

Give some causes of HF other than IHD

Answer 3

o	Hypertension
o	Cardiomyopathies
	Alcohol/Drugs/Poisoning
	Iron overload
	Pregnancy
o	Valvular heart disease / Congenital
o	Restrictive cardiomyopathy e.g. amyloidosis
o	Hypertrophic cardiomyopathy
o	Pericardial disease
o	Arrhythmia

Question 4

What is prognosis after MI related to?

Answer 4

Prognosis after MI (or any cardiac injury) is inversely related to the amount of left ventricular damage/dysfunction.

Question 5

What are the four ways in which heart failure is managed?

Answer 5

o	Correct underlying cause
o	Non-pharmacological measures
o	Pharmacological therapy
	Symptomatic improvement
	Delay progression of heart failure
	Reduce mortality
o	Treat complications/associated conditions/CVS risk factors
	E.g. arrhythmias

Question 6

How can you improve HF prognosis?

Answer 6

o RAAS Antagonism
 ACE inhibitor – E.g. Ramipril
 Angiotensin Receptor Blocker – E.g. Losartan
 Aldosterone blockade – E.g. Spironolactone
o Beta-Blocker
 E.g. Propranolol, Atenolol

Question 7

Give five drugs used to treat HF

Answer 7

o -blockers
 Block 1 receptors on the myocardium
o ACE-Inhibitors
 Prevent conversion of Angiotensin I  II
o Ca2+ channel blockers
 Reduce contractility of the myocardium
o Organic Nitrates
 Venodilator – Reduce preload on heart, lowering its O2 requirement
 Vasodilator – Coronary arteries dilate, supplying more O2.
o Cardiac Glycosides
 Increase CO and heart contractility by inhibiting the Na/K pump. Raising intracellular Na inhibits NCX, so intracellular Ca2+ increases  in. contractility