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MD3001 Cardiology > Pharmacological Treatment of Heart Failure > Flashcards

Pharmacological Treatment of Heart Failure Flashcards

1
Q

What are the aims of treatment of left ventricular systolic dysfunction?

A
  • relieve symptoms
  • improve exercise tolerance
  • reduce incidence of acute exacerbations
  • reduce mortality
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2
Q

What are the strategies for treatment for LVSD?

A
  • increase cardiac contractility
  • decrease preload/afterload to decrease cardiac demand
  • inhibit RAAS
  • prevent inappropriate increase in HR
  • mobilise oedematous fluids
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3
Q

What are the non-pharmacological methods of treatment of LVSD?

A
  • lifestyle factors

- device therapy (pacemakers/transplant/revascularisation etc)

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4
Q

List the main drugs used in chronic heart failure

A
  • loop diuretics (furosemide/bumetanide)
  • ACE inhibitors (ramipril/lisinopril)
  • ARBs (candesartan/losartan)
  • B-blockers (bisoprolol/carvedilol)
  • aldosterone receptor antagonists (spironolactone)
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5
Q

What is the first line of treatment of chronic heart failure?

A
  • ACE inhibitor/ARB and B-blocker

- diruretic if there is fluid retention

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6
Q

What drugs increase excretion of sodium and water?

A
  • loop diuretics (furosemide/bumetanide)

- aldosterone receptor antagonists (spironolactone)

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7
Q

Describe flexible loop diuretic regimes

A
  • only used if patient shows clinical signs/symptoms of tissue congestion
  • aim is to achieve a dry weight (no build up of fluid) using lowest diuretic dose possible
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8
Q

What self-management does a patient have to do when on a loop diuretic regime?

A
  • daily weights (if varies, dose altered)
  • review symptoms (breathless/oedema)
  • thirst level/dizziness
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9
Q

What are the side effects of loop diuretics?

A
  • electrolyte disturbances
  • hypotension
  • renal impairment
  • hypovolaemia
  • nocturia
  • acute gout
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10
Q

When are renin-angiotensin system inhibitors used?

A
  • heart failure with reduced ejection fraction

- reduce morbidity/mortality

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11
Q

What effect do ACE inhibitors and ARBs have in heart failure?

A
  • reduce salt and water retention
  • reduce vasoconstriction
  • reduce vascular resistance
  • reduce afterload
  • improve tissue perfusion
  • reduce ventricular remodelling and hypertrophy
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12
Q

What side effect is specific to ARBs?

A

back/leg pain

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13
Q

What are the common side effects of renin-angiotensin system inhibitors?

A
  • dizziness
  • headache
  • risk of hyperkalaemia
  • renal impairment
  • teratogenic
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14
Q

What positive effects do B-blockers have in heart failure?

A
  • allows ventricle to fill more completely in diastole
  • some cause vasodilation by blocking alpha-receptors and decrease afterload
  • reduce renin release in kidney
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15
Q

What are the risks of B-blockers?

A
  • risk of bradycardia

- AV block if patient takes: digoxin/amiodarone/verapamil/diltiazem

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16
Q

What are the common side effects of B-blockers?

A
  • bradycardia
  • fatigue
  • SOB
  • dizziness
  • cold peripheries
  • reduced libido
  • insomnia
17
Q

When would you use an aldosterone antagonist?

A
  • add if ACEI/ARB and B-blocker and diuretic and the patient still has symptoms
  • in severe heart failure
18
Q

What are the common side effects of aldosterone receptor antagonists?

A
  • hyperkalaemia
  • hyponatraemia
  • nausea
  • hypotension
  • gynaecomastia (spironolactone)
  • renal impairment
19
Q

What if ACE inhibitor/ARBs and B-blocker and diuretic and aldosterone receptor antagonists don’t relieve all symptoms?

A
  • sacubitril (neprilysin inhibitor) and valsartan combination
  • ivabradine: specialist use only, reduces HR but not contractility by acting on SA node, only used if HR is less than 75
20
Q

How would you treat persistent sodium/water retention?

A

Additional diuretics (thiazide)

21
Q

How would you treat concurrent co-existing angina?

A
  • oral nitrates

- amlodipine

22
Q

When would you use digoxin in HF and why?

A
  • if other strategies fail
  • doesn’t reduce mortality rate
  • narrow therapeutic window
23
Q

Describe the mechanism of digoxin in HF

A
  • indirectly increases Ca levels and storage in SR
  • inhibits Na/K ATP-ase pump affecting Na/Ca exhanger
  • elevates intracellular calcium in SR
  • when released from SR strengthens contractility
24
Q

What are the side effects of digoxin?

A
  • GI upset
  • dizziness
  • conduction abnormalities
  • blurred/yellow vision
25
Q

What are the aims of treatment of acute heart failure?

A
  • normalise ventricular filling pressures

- restore adequate tissue perfusion

26
Q

What are the first and second line treatments of acute heart failure?

A
  • first line: LMNOP (loop, morphine, nitrates, oxygen, positioning)
  • second line: ionotropic agents
27
Q

Explain the mechanism of action of ionotropic agents in HF

A
  • increase contractility
  • increase SV and CO
  • increased clearance of blood in ventricles
  • as CO increases baroreceptors sense change in MABP and decrease sympathetic dirve decreasing HR and TPR
28
Q

What are the specific examples and uses of ionotropes?

A
  • dobutamine: patients with cardiogenic shock to maintain BP
  • dopamine: increases renal perfusion at low dose, increases BP at high dose
  • isoprenaline: bradycardia/heart block emergency
  • adrenaline
29
Q

What action do vasopressors do and when are they used?

A
  • vasoconstriction
  • raise BP
  • used in severe septic shock

MD3001 Cardiology (56 decks)

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