Heart Failure Flashcards
(25 cards)
What is the treatment for HF with preserved ejection fraction?
manage co-morbidities
- HTN, AF, IHD, DM
cardiac rehabilitation programme
What is the line of treatment for HF with reduced ejection fraction?
ACEi (or ARB then hydralazine + nitrate if not tolerated) + BB: carvedilol, bisoprolol, nebivolol
MRA: spironolactone if symptoms continue
if symptoms persist
- replace ACEi/ARB with sacubitril/valsartan: if EF < 35%
- ivabradine: if sinus rhythm + HR >75 + EF < 35%
- hydralazine + nitrate
- digoxin: sinus rhythm
When is hyralazine + nitrate preferred in HF?
Preferred for those of African-Caribbean descent
Add on for resistant HF
What must be monitored for ACEi, ARB and MRAs?
electrolytes: sodium, potassium
renal function
What are the symptoms of HF?
SOB
pulmonary oedema
ankle swelling
paroxysmal nocturnal dyspnoea
pink tinged sputum
fatigue
When should a diuretic be added to HF treatment?
fluid overload
loop diuretic
thiazide: if mild HF and eGFR > 30
What are the treatment options for HF?
ABCD — BANDAIDS
ACEi/ARB, BB, CCB, Diuretics
BB, ACEi/ARB, Nitrate/Hydralazine, Diuretics, Amiodarone, Ivabradine, Digoxin, SGLTi
What should be monitoried for beta blockers?
heart rate
blood pressure
symptom control
lung function
When does a dose adjustment have to be made for eplerenone?
CYP 3A4 inhibitors: amiodarone
- reduce to 25mg OD
renal impairment
- 30-60ml/min: 25mg alternate days
- < 30ml/min: avoid
When is the use of sacubitril/valsartan CI?
concomitant use with ACEi or ARB
- angioedema risk
- must wait 36 hrs before starting
When is ivabradine CI?
HR < 75 bpm for CHF
HF < 70 bpm for angina
What are side effects of ivabradine?
arrhythmias
What are the monitoring requirements for ivabradine?
atrial fibrillation: S/E is arrhythmias
bradycardia: discontinue if HR < 50bpm
What factors can cause digoxin toxicity?
HYPERcalcaemia
HYPOkalaemia
HYPOmagnesemia
HYPOxia
What can occur with nitrate use?
tolerance
- can be developed when using long acting or transdermal nitrates
- leave off patches for 8-12 hrs or leave an 8hr gap between MR tabs
What are the side effects of nitrates?
arrhythmias
peripheral oedema
headache
flushing
hypotension
What monitoring is needed for nitrates?
blood pressure
heart rate
What counselling is needed for nitrates?
avoid abrupt withdrawal
What are the main drug interactions for nitrates?
phosphodiesterase-5 inhibitors: sildenafil
- hypotension
When should loop diuretics be avoided?
anuria (no urine output)
severe: HYPOkalaemia and HYPOnatraemia
How can diuretics lead to encephalopathy?
loop diuretics can cause HYPOvolaemia which leads to encephalopathy
- esp in hepatic impairment
How can diuretics cause arrhythmias?
loop diuretics can cause increased hypomagnesemia in alcoholic cirrhosis leading to arrhythmias
What monitoring is needed for loop diuretics?
electrolytes: sodium, potassium, calcium, chloride, magnesium
What are the main drug interactions for diuretics?
aminoglycosides + vancomycin: ototoxicity
antidepressants (TCAs, MAOi): hypotension
digoxin: digoxin toxicity
corticosteroids: antagonise diuresis/cause fluid retention, increased hypokalaemia risk
