treatment of cardiac failure Flashcards
(56 cards)
aims of treatment for HF?
- relieve symptoms
- improve exercise tolerance
- reduce incidence of acute exacerbations
- reduce mortality
strategies for treatment?
- increase contractility
- decrease preload and/or after load in order to decrease cardiac work demand:
by relaxing vascular smooth muscle and by reducing blood volume. - inhibit the RAAS
- prevent inappropriate increase HR
- mobilise the oedematous fluids
what are lifestyle modifications that an be made for treatment of HF?
- Smoking cessation
- Salt and fluid restriction (improves mortality)
- Supervised cardiac rehabilitation
- Keep vaccines up to date
- Lorry/bus drivers need to notify the DVLA if they are symptomatic
what are “devise therapy for treatment of hypertension?
- pacing
- cardiac resynchronisation therapy
- implantable cardiac defibrillators
- coronary revascularisation
- heart transplant
what are the 5 main drugs used in treatment of HF and Hf with receded ejection fraction (HFrEF)
1- loop diuretics (furosemide, bumetanide)
2- ACE inhibitors (ramipril, lisinopril)
3- angiotensin 2 receptor blockers (candesartan, losartan)
4- beta blockers (bisprolol)
4- aldosterone receptor antagonists (spironolactone)
step 1 treatment of chronic HF?
DAB
D= diuretic if fluid retention
A= ace inhibitor or ARB
B = beta blocker
what is A and B alone in step one shown to do?
reduce mortality and improve the quality of life
what do kidney function modifiers do in HF?
they increase excretion of sodium and water
step 1 for modifying kidney function in HF?
loop dietetics - this will effect the thick ascending loop of henle
step 2 for modifying kidney function in HF?
spironolactone - this will effect the collecting tubule
what is the use and aim for flexible loop dietetic regimes?
use = if l=clinical signs/ symptoms of fluid overload/congestion
aim= achieve a ‘dry’ weight using the lowest diuretic dose possible
describe patient self management with edu?
- daily weight = if it varies in either direction then alter the dose
- symptom review = breathlessness, peripheral oedema
- thirst level
what are loop diuretic common side effects?
- electrolyte disturbances
- hypotension
- renal impairment
- hypovolaemia
- nocturia is taken too late in day
- acute gout common with high dose
acute hypertension treatment?
- Lasix (furosemide) IV
- Morphine IV
- Nitrates - sublingual or oral
- Oxygen
- Position - sit patient up
- Treat cause of decompensation (MI, arrythmia, myocarditis)
- β-blockers contraindicated
what is the nmominic to remember the main drugs used in HF?
ABBA
A= ACEI (angiotensin converting enzyme inhibitor)
B= Beta Blocker
A = Aldosterone antagonist
at what part of the kidney will loop diuretics have an effect?
thick ascending loop of henele
at what part of the kidney will thiazides have an effect?
distal tubule
at what part of the kidney will spironolactone have an aeffcect?
collecting tube
when would you use Renin Angiotensin System inhibitors?
what will it do?
- use in heart failure with a reduced ejection fraction of all the NYHA classes
- it will reduce morbidity/ mortality
what are the Angiotensin Converting enzyme inhibitors?
ramipril
lisinopril
what are the effects of using ACEI and ARB’s in HF?
- reduce salt and water retention
- reduce vasoconstriction
- reduce vascular resistance
- reduce after load
- improve tissue perfusion
-reduce ventricular remodelling and hypertrophy
in what group of patients is ACEI and ARB’s less effective?
what drugs should you use instead?
African or Caribbean ethnicity
- try hydralazine + nitrate
how would you administer ACEI and ARB’s?
start on a low dose, monitor the BP and blood chemistry and symptoms and uptitrating to maximum tolerated or target dose.
common side effects of RAAS inhibitors?
- dizziness
- headache
- hyperkalaemia
- renal impairment
avoid in bilateral renal artery stenosis
