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Flashcards in Heart Failure Treatment Deck (54)
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1

Chronic heart failure is a syndrome characterised by what?

Progressive cardiac dysfunction
Breathlessness
Tiredness
Neurohormonal disturbances
Sudden death

2

What are the types of heart failure and their features?

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

Diastolic HF - involves a thickened and stiff heart muscle, as a result the heart does not fill up with blood properly which results in fluid back-up in the lungs and heart

3

What percentage of the population are affected by chronic heart failure?

2-10%

4

What is the 5-year mortality of heart failure?

50%, rising to 80% in a year for some patients

5

What are the risk factors for heart failure?

Coronary artery disease
Hypertension
Valvular heart disease
Alcoholism
Infection
Diabetes
Congenital heart defects
Obesity
Age
Smoking
High or low haematocrit level
Obstructive sleep apnoea

6

What is the basic pathological progression of cardiovascular disease?

Cause/risk factor
Myocardial injury, neurohormonal stimulation and myocardial toxicity
Pathological remodelling
Low ejection fraction, resulting in symptoms (dyspnoea, fatigue, oedema etc.)
Chronic heart failure

7

What is involved in neuroendocrine activation in heart failure?

Salt and water retention

Activation of:
RAAS
Sympathetic system
Endothelin system
Natriuretic peptide system ANP/BNP
EDRF

8

What are the two main aims of treatment for heart failure?

To improve symptoms
To improve survival

9

What are the types of treatment regimens for heart failure?

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

10

What drugs are used for symptomatic heart failure treatment?

Diuretics
Digoxin
ACE inhibitors/ARBs

11

How do loop diuretics treat heart failure?

Removes excess salt and water - induce profound diuresis
Inhibit the Na-K-CL transporter in the loop of Henle
Prevent reabsorption of 20% of filtered sodium and water
Work at low glomerular filtration rates

12

What can be used in diuretic resistant patients?

A combination of thiazide diuretics

13

What are the potential adverse drug reactions of loop diuretics?

Dehydration
Hypotension
Hypokalaemia
Hyponatraemia
Gout
Impaired glucose tolerance/diabetes

14

What are the potential drug-drug interactions of loop diuretics?

Furosemide and aminoglycosides - aural and renal toxicity
Furosemide and lithium - renal toxicity
Furosemide and NSAIDs - renal toxicity
Furosemide and anti-hypertensives - profound hypotension
Furosemide and vancomycin - renal toxicity

15

What drugs are used to block the effects of angiotensin II in the RAAS?

ACEIs e.g. ramipril
Angiotensin antagonists e.g. valsartan, losartan

16

What drug can be used to block the effects of aldosterone?

Spironolactone

17

What is the risk reduction carried by ACEIs?

35%

18

What pathophysiologies do ACEIs interfere with?

Pathophysiology of coronary ischaemia and renal insufficiency

19

Give examples of ACEIs

Ramipril
Enalapril
Lisinopril

20

How do ACEIs work?

Competitively block angiotensin converting enzyme to prevent the conversion of angiotensin I to angiotensin II
Reduce preload and afterload on the heart

21

What effect do ACEIs have on CHF patients?

Significantly reduce morbidity and mortality

22

What effect do ACEIs have on post-MI patients?

Reduce morbidity, mortality and onset of HF

23

What are the potential adverse drug reactions of ACEIs?

First dose hypotension
Cough
Angioedema
Renal impairment
Renal failure
Hyperkalaemia

24

What are the potential drug-drug interactions of ACEIs?

NSAIDs - acute renal failure
Potassium supplements - hyperkalaemia
Potassium sparing diuretics - hyperkalaemia

25

How do angiotensin receptor blockers work?

Selectively block the angiotensin II AT1 receptor

26

When are ARBs recommended in heart failure?

In ACEI intolerant patients

27

What is sacubitril-valsartan?

Combination drug of ARB and neprilysin inhibitor

28

How does sacubitril-valsartan work?

ARB (valsartan) blocks AT1 receptor
Neprilysin is responsible for the degradation of ANP and BNP, sacubitril inhibits neprilysin

29

What is spironolactone?

Potassium sparing diuretic

30

How does spironolactone work?

Inhibits the actions of aldosterone
Acts in the distal tubule