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Cardiovascular system SA > Heart failure treatment > Flashcards

Heart failure treatment Flashcards

1
Q

What is the pathology in systolic heart failure

A

Decreased pumping function of the heart, which results in fluid back up in the lungs and heart failure

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2
Q

What is the pathology of diastolic heart failure

A

Involves a thickened and stiff heart muscle
so the heart does not fill with blood properly
resulting in fluid backup in the lungs and heart failure

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3
Q

What is the risk factors for heart failure

A 
Coronary artery disease
Hypertension (LVH)
Valvular heart disease
Alcoholism
Infection (viral)
Diabetes
Congenital heart defects
Age/smoking/obesity/
obstructive sleep apnea
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4
Q

How does systolic dysfunction get increasing worse

A

As the heart reduces its cardiac output due to loss of pumping ability - causes the heart to dilate ad decreases force of contraction which causes a further decrease in cardiac output

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5
Q

What does a decreased cardiac output in systolic dysfunction active,

A

RAAS activation

Sympathetic activation

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6
Q

What happens to the heart as it continues to dilate

A

cardiac myocytes undergo hypertrophy and then fibrosis and thus the heart is further weakened

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7
Q

What is the affect of RAAS and sympathetic activation

A

The result is salt and water retention, vasoconstriction

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8
Q

How does heart failure lead to oedema

A

RAAs activation causes salt and water retention increasing circulatory volume resulting in oedema

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9
Q

What is the different treatment methods of symptomatic treatment

A

Inhibition of detrimental neurohormonal adaptations
Enhancement of beneficial neurohormonal adaptations
Enhancement of cardiac function

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10
Q

What is the main symptomatic treatment in heart failure

A

Loop diuretics
FUROSEMIDE or BUMETANIDE

Inhibit the NA-K-Cl transporter in the Loop of Henle - remove excess salt and water

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11
Q

What treatment blocks the sympathetic activation in heart failure and examples

A

Beta blockers

CARVEDILOL, BISOPROLOL METOPROLOL

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12
Q

What are the two sets of drugs that block the affects of angiotensin II released in RAAS activation

A

ACE Inhibitors (Ramipril )

Angiotensin antagonists (Valsartan, Losartan)

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13
Q

What drug is a aldosterone antagonist

A

SPIRONOLACTONE

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14
Q

What beneficial hormonal change does drug treatment want to target in the treatment of heart failure and why>

A

Natriuretic peptide system

Atrial natriuretic and Brain peptides are potent natriuretic agents and vasododilators

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15
Q

What drug therapies enhance cardiac function in the treatment of heart failure

A

Positive iotropes:
Digoxin - improve the pumping ability of the heart

Vasodilators:
Isosorbide mononitrate/dinitrate: reduce preload and after load

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16
Q

What loop diuretic is more likely to be used in old age patients and why

A

Bumetanide - due to slow onset

17
Q

What does it mean that loop diuretics work at very low glomerular filtration rates

A

Continue working if kidney becomes impaired

18
Q

What can be used with loop diuretics if patients show a resistance

A

thiazide diuretics

19
Q

What is loop diuretic and thiazide diuretic a short term treatment

A

due to the adverse drug reactions of;

Dehydration
Hypotension
Hypokalaemia, Hyponatraemia
Gout
Impaired glucose tolerance, diabetes
20
Q

What is the main outcome of drug interactions with fursemide

A

Renal toxicity

due to aminoglycosides, lithium, NSAIDS, vancomysin

21
Q

What drug therapies are used for reducing mortality in heart failure

A

Angiotensin Blockade
Beta receptor blockade
Aldosterone blockade
ANP/BNP enhancement

22
Q

What is examples of angiotensin converting enzymes inhibitors ACEI and how do they work

A

RAMIPRIL, ENALAPRIL, LISINOPRIL

Prevent the conversion of angiotensin I to angiotensin II
Reduce preload and after load on the heart

23
Q

What is the adverse drug reactions of ACE inhibitors

A 
First dose hypotension
Cough
Angioedema
Renal impairment
Renal failure
Hyperkalaemia
24
Q

What drugs interact with ACE inhibitors to cause hyperkalaemia

A

Potassium supplements

Potassium sparing diuretics

25
Q

What is the drug interaction caused by ACE inhibitor and NSAIDS

A

acute renal failure

26
Q

How does Angiotensin receptors blockers work in the treatment of heart failure and when are they used

A

ARBs selectively block the angiotensin II, AT1 receptor.

In ACEI intolerant patients

27
Q

What is the affect of blocking angiotensin 11 AT1 receptor

A 
Prevent; 
Vasoconstriction
Vascular proliferation 
Aldosterone secretion
Cardiac myocyte proliferation
Increased sympathetic tone
28
Q

What is an example of a drug that prevents the break down of ANP and DNP therefore enhancing natural diuretics in the body

A

Neprolysin

29
Q

How and where do Potassium sparing diuretic drugs work

A

interfering with the sodium-potassium exchange in the distal convoluted tubule in the kidneys

30
Q

When are aldosterone antagonists particularly useful

A

In heart failure with resistant oedema

31
Q

When should beta blockers be administrated in heart failure

A

Should be used only when a patient has been stabilized

and not during an acute presentation

do not give to patients with fluid retention Can cause further deterioration

32
Q

How does the ivabradine reduce heart rate in the treatment of heart failure

A

reduces heart rate

specific inhibitor of the If current in the sinoatrial node.

33
Q

What heart failure patients should be administered ivabradine

A

Only in patients with high hart rate above 70bpm

34
Q

How does digoxin work in reducing the symptoms in heart failure

A

Increases availability of calcium in the myocyte - Therefore improving hearts pumping ability
= symptomatic

35
Q

What is the adverse reactions cause by the narrow therapeutix index of digoxin

A

Arrhythmias
Nausea
Confusion

36
Q

Why and when would digoxi treatment be offered

A

Offered to improve cardiac status near the end stage

avoided due to toxicity

37
Q

Whys is warfarin anticoagulant used in heart failure treatment

A

Acts as a prevention of the formation of thromboembolic events

38
Q

What is the full treatment regime in heart failure

A 
Furosemide ± thiazide	
Furosemide 
ACE Inhibitor			
Angiotensin receptor blocker
ARNI
Beta-blocker ± Ivabradine
MRA-spironolactone 	
Digoxin				
Warfarin
39
Q

How do you monitor the benefit of the treatment

A

Monitor weight regular to check fluid loss/retention

Cardiovascular system SA (43 decks)

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