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Semester 2 > Heart Failure - Treatment > Flashcards

Heart Failure - Treatment Flashcards

1
Q

Learning Outcomes

A
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2
Q

What is heart Failure Characterised by?

A

–by progressive cardiac dysfunction

–breathlessness

–tiredness

–neurohormonal disturbances

–sudden death

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3
Q

What is congestive heart failure defined as?

A

Heart unable to pump blood that meets the demands of the tissues or it can do so but only from high pressures.

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4
Q

What are the two types of heart failure?

A

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

Diatolic heart failure

(HFrEF - heart failure with presereved ejection fraction)

Diastolic Heart Failure - Thickened and stiff heart muscle

  • Heart does not fill properly with blood
  • Fluid back up in the lungs and hear failure

(HFpEF) - Heart failure with preserved ejection fraction

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5
Q

Risk factors for heart failure

A
  • Coronary artery disease
  • Hypertension (LVH)
  • Valvular heart disease
  • Alcoholism
  • Infection (viral)
  • Diabetes
  • Congenital heart defects
  • Other:

–Obesity

–Age

–Smoking

–High or low hematocrit level

–Obstructive Sleep Apnea

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6
Q

What is the effect of heart failure on Frank - Starling Law?

A

Failing heart causes the relationship to be lost - amount of stretch is no longer proportional to the force of contraction

Circulatory volume increases - heart dilates - force of contraction reduces and there is a further drop in cardiac output.

Activation of the RAAS (renin angiotensin aldosterone system)

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7
Q

When does heart failure usually occur?

A

Following sustained hypertension

As a result of myocyte damage - MI

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8
Q

What is the result of a reduced cardiac output on blood pressure?

A
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9
Q

What is the effect of –Atrial and Brain Natriuretic Peptides?

A
  • Potent vasodilators and natriuretic peptides
  • Short halflife
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10
Q

What are the drugs for the treatment of symptoms?

A
  • Diuretics
  • Digoxin
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11
Q

What is the treatment for the improvement of symptoms and survival?

A
  • ACE inhibitors/ARBs
  • Spironolactone
  • Valsartan-sacubitril
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12
Q

What are the goals of treatment?

A
  • Symptomatic treatment
  • Inhibition of detrimental neurohormonal adaptations
  • Enhancement of beneficial neurohormonal adaptations
  • Enhancement of cardiac function
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13
Q

Give examples of loop diuretics

A

–FUROSEMIDE or BUMETANIDE

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14
Q

How is sympathetic activation blocked?

A

Beta blockers - in this case:

–CARVEDILOL, BISOPROLOL and METOPROLOL are beta blockers which are of proven benefit in the treatment of CHF

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15
Q

What are the two types of drugs that block the effects of angiotensin 2?

A

Ace inhibitors (Rampril)

Angiotensin antagonists

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16
Q

How is aldosterone blocked?

A

Spironolactone - Produces a significant reduction in morbidity

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17
Q

What are the beneficial hormonal changes that we want to enhance?

A

Natriuretic peptide system

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18
Q

What metabolises brain and heart natriuretic peptides?

A

Neutral endopeptidse

19
Q

What is the effect of digoxin?

A

Enhances cardiac function - improves cardiac statue

Digoxin toxicity is a very likely

20
Q

What is the effect of vasodilators?

A

Reduce preload and afterload - improving cardiac function

–Hydralazine an arterial dilator has also been shown to improve cardiac function

21
Q

Give examples of vasodilators

A

ISOSORBIDE MONO or DINITRATE

22
Q

How do loop diuretics work?

A

Inhibit the sodium potassum chlorine transporter in the loop of henle- inducing profound diuresis.

23
Q

What are the adverse drug reactions for diuretics?

A

–Dehydration

–Hypotension

–Hypokalaemia, Hyponatraemia

–Gout

–Impaired glucose tolerance, diabetes

24
Q

What are the drug drug interactions wih frusemide?

A
25
Q

What are the drugs needed for reducing mortality?

A
  • Angiotensin Blockade
  • Beta receptor blockade
  • Aldosterone blockade
  • ANP/BNP enhancement
26
Q

What are the relevant ACEi?

A

RAMIPRIL, ENALAPRIL, LISINOPRIL

27
Q

What are the adverse drug reactions of ACEi?

A

–First dose hypotension

–Cough

–Angioedema

–Renal impairment

–Renal failure

–Hyperkalaemia

28
Q

What are the drug drug interactions with ACEi?

A

–NSAIDs acute renal failure

–Potassium supplements hyperkalaemia

–Potassium sparing diuretics hyperkalaemia

29
Q

How does the effectiveness of ARB’s compare with ACEi?

A

NOT as effective

30
Q

What is the role of AT1 and AT2 receptors?

A

ARB’s act on the AT1 receptor

31
Q

What is the effect of neprilysin?

A

Stops break down of BNP and ANP by neutral endopeptidases

32
Q

What is Valsartan - Sacubitril?

A

Combined valsartan and ARB and Neprilysin

33
Q

What is the effect of spironolactone?

A

Aldosterone antagonist

Potassium sparing diuretic

Acts in distal tubule

Used in combination with loop diuretics

Particularly useful in resistant oedema

Proven to reduce mortality when used in combination with ACEI’s

34
Q

What is the major risk attached to beta blockers?

A

May precipitate severe deterioration in CHF

35
Q

When type of onset are beta blockers used for?

A

–Should be used only when a patient has been stabilized and not during an acute presentation

36
Q

What is the aim of ivabradine?

A

To improve survival

37
Q

What is the effect of Ivabridine?

A

Specific inhibitor of current in sinoatrial node

  • No action on other channels in the heart or vascular system.
  • Does not modify myocardial contractility and intracardiac conduction, even in patients with impaired systolic function.
38
Q

Whos is Ivabridine recommended for?

A

Stable chronic HFrEF

Maximum tolerated dose of beta blockers

In sinus rhythm

Have a heart rate of 70 bpm or greater at rest

39
Q

What are the effects of Digoxin?

A

Increases the availability of calcium in the myocyte

No effect on mortality but it can reduce hospitilisations

Narrow therapeutic index

40
Q

What are the side effects of digoxin?

A

Arrhythmias

Heart block

Nausea

Confusion

41
Q

What is the purpose of warfarin in the treatment of heart failure?

A

–Dilated ventricle gives rise to thrombus formation and thrombo-embolic events

–Warfarin has proven value in preventing these events

42
Q

What is the therapeutic regime?

A

Where ARNI is the Valsartan and Salcubitril (Neprilysin)

43
Q

How do you monitor benefit?

A

Measuring weight is the only effective way to measure the loss on body fluids - urine volumes are unreliable

44
Q
A

Semester 2 (150 decks)

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