Htn And Heart Failure Flashcards

Question

What are the other options

Answer 1

Spironolactone, labetalol • If A, C or D are not effective or contraindicated then several other classes can be considered • ACE inhibitor first line for hypertension in HF and DM patients • Alpha-adrenoceptor blockers • Beta-adrenoceptor blockers • Spironolactone – mineralocorticoid/aldosterone receptor antagonist • Amiloride – K+ sparing acting on distal tubule • Direct renin inhibitor – aliskirin • Other direct vasodilators – nitrates e.g. SNP (hypertensive emergency i.v.) • Centrally acting drugs – labetalol (pregnancy, hypertensive emergency i.v.) - reduce sympathetic outflow - not typically in primary practice but p.o. labetalol in pregnancy

Answer 2

``` Eg doxazosin • Selective antagonism at post-synaptic α-1 adrenoceptors and antagonise the contractile effects of noradrenaline on vascular smooth muscle • Reduce peripheral vascular resistance • Benign effect on plasma lipids/glucose • Safe in renal disease ```

Answer 3

Adverse effects: • Postural hypotension.........Dizziness • Headache and fatigue • Oedema (especially if combined with dihydropyridine)

Answer 4

Eg bishop roll Decrease sympathetic tone by blocking Nad and reducing myocardial contraction → ↓ CO (↓ renin secretion) affording antihypertensive effects

Answer 5

* Can cause bronchoconstriction so contraindicated in asthmatics and COPD also in 2nd/3rd degree heart block * Also mask tachycardia – sign of insulin induced hypoglycaemia – caution in diabetics * Lethargy and impaired concentration * Reduce exercise tolerance * Bradycardia * Raynaud’s (cold hands)

Answer 6

• Cardiac output (CO) ~ 5L/min in a typical adult • CO varies in response to both physiological and pathological factors - preload – filling pressure (LVEDP – surrogate for sarcomere length) - afterload – “load” that ventricle must eject blood against - contractility - heart rate • Abnormality in cardiac function which is responsible for the failure of the heart to pump blood at a rate commensurate with the requirements of metabolising tissues • Characterised by symptoms that may present and often in later stages of HF - exercise intolerance, breathlessness, fatigue (swelling) • Acute heart failure – the result of sudden circulatory collapse – haemorrhagic shock or cardiogenic shock during AMI, sepsis

Answer 7

• • Usually, there is some form of cardiomyopathy “disease of the myocardium associated with cardiac dysfunction” (WHO, 1995) many causes of cardiomyopathy -inherited congenital hypertrophic CM arrhythmogenic RV CM -acquired ischaemic cardiomyopathy pressure overload valve disease infection/inflammation/alcohol

Answer 8

Physiological neurohormonal response in its attempt to compensate will eventually lead to further pathology- ss

Answer 9

• Usually dealing with LV systolic dysfunction associated with reduced LV ejection fraction (<45%) • Where there is preserved EF (e.g. diastolic heart failure or high output failure), optimal treatment is not clearly defined • Correct underlying cause (replace valve, angioplasty) • Non pharmacological management – ↓↓salt intake, liquid reduction ~ 1.5L AIMS of treatment are: • reduction in symptoms (dyspnoea, fatigue, oedema) • Managed increase in exercise tolerance • decreased mortality • address arrhythmias, hyperlipidaemia, diabetes Diuretics, typically furosemide, are used in most patients symptomatically (congestive symptoms) but have little impact on survival furosemide

Answer 10

• useful in ALL grades of LV dysfunction and there is a drug class effect • LOW INITIAL DOSE reduces risk of sudden rapid fall in BP, especially in patients already taking diuretics • monitor renal function within first few weeks • if ACE inhibitor not tolerated, an AT1 antagonist (ARB) may be used as alternative • ARBs have essentially similar benefit as ACE inhibitor in HF, typically start with ACE inhibitor, if not tolerated then ARB (under close supervision of cardiologist can be used together)

Answer 11

* In some individuals refractory hyperaldosteronism occurs (RAAS gene polymorphism?) (sometimescalledaldosteroneescape) * Typically used as adjunct to max ACE inhibitor and diuretic * 1663 patients NYA class III/IV * LVEF ≤ 35% * ACE inhibitor, loop diuretic and digoxin (most) * 25 mg spironolactone SID * All cause mortality

Answer 12

• recommended for ALL patients with stable CHF unless contraindicated or not tolerated • introduce once ACE inhibitor or AT1 antagonist (ARB) therapy is initiated • benefit is related to blunting of sympathetic influences especially on heart rate • slower HR → longer diastolic filling period → better filling→ more output • may also stabilise electrical conduction (class I antiarrhythmic effect) reducing arrhythmia • may also blunt circulating RAAS directly inhibiting renin, but probably minor effect since ACE inhibitors already used • LOW initial dose which may cause transient worsening of symptoms (e.g. fatigue, poor exercise tolerance)

Htn And Heart Failure Flashcards

(36 cards)