Week 3 topic 6 Flashcards
(23 cards)
What is acute decompensated heart failure?
A clinical syndrome characterized by sudden or gradual onset of signs and symptoms such as dyspnea, orthopnea, peripheral edema, pulmonary congestion, and low cardiac output.
It can lead to cardiogenic pulmonary edema and hypoperfusion of vital organs.
What are common signs and symptoms of acute decompensated heart failure?
- Dyspnea
- Orthopnea
- Peripheral edema
- Pulmonary congestion
- Pleural effusion
- Low cardiac output
- Elevated left ventricular filling pressures
- Hypoperfusion of vital organs with or without pulmonary edema
Examples include renal failure and encephalopathy.
What is the treatment focus for ‘Warm & Wet’ acute decompensated heart failure?
Diuretics + vasodilators (e.g. nitrates)
This profile is the most common presentation.
What treatment is indicated for ‘Cold & Wet’ acute decompensated heart failure?
Inotropes (e.g. dobutamine) ± vasodilators if BP allows
This condition is characterized by congestion and hypoperfusion.
What pharmacological agents are used to manage acute decompensated heart failure?
- Diuretics (e.g. furosemide)
- Nitrates (e.g. nitroglycerin)
- Oxygen
- Non-invasive ventilation (CPAP or BiPAP)
- Inotropes (e.g. dobutamine, milrinone)
- Intra-aortic balloon pump
These agents focus on reducing blood volume, improving oxygen delivery, and enhancing cardiac contractility.
What is the role of diuretics in acute decompensated heart failure?
Increase salt and water loss, reduce blood volume, lower excessive venous filling pressure, and reduce pulmonary and peripheral congestion and edema.
Common diuretics include furosemide, bumetanide, and torsemide.
How do nitrates function in treating acute decompensated heart failure?
Dilate smooth muscle in venous capacitance vessels, increase venous vascular bed volume, reduce ventricular filling pressure, and decrease myocardial oxygen requirements.
Examples include nitroglycerin and nitroprusside.
When is oxygen indicated in the management of acute decompensated heart failure?
Indicated if SpO2 is <90%. Not routinely required if the patient is not hypoxic.
It increases oxygen delivery to hypoxic tissues.
What is the purpose of non-invasive ventilation in acute decompensated heart failure?
Improves oxygenation, reduces work of breathing, and reduces preload and afterload by increasing intrathoracic pressure.
It is used in patients with severe pulmonary edema and respiratory distress.
What is the function of inotropes in acute decompensated heart failure?
Enhance cardiac contractility to increase cardiac output.
Reserved for hypotensive or cardiogenic shock patients with low cardiac output.
What are the key pharmacological treatments for chronic heart failure?
- ACE inhibitors
- ARBs
- β-blockers
- ARNI
- MRA
- SGLT2 inhibitors
- Digoxin
Stage C patients are the main group being treated.
What is the mechanism of action of ACE inhibitors in chronic heart failure?
Inhibit conversion of AngI to AngII, reducing afterload and preload, and preventing aldosterone formation.
They are unique in reducing peripheral resistance without causing reflex sympathetic activation.
What is the role of β-blockers in chronic heart failure?
Decrease heart rate, cardiac remodelling, and myocardial oxygen demand, lowering mortality and decreasing hospitalisation.
They are typically added to conventional treatments.
How does spironolactone help in chronic heart failure?
Acts as a diuretic by blocking the aldosterone receptor and has a powerful effect on outcomes in heart failure.
Plasma aldosterone levels are raised in heart failure.
What is the effect of digoxin in chronic heart failure?
Improves myocardial contractility, especially in the dilated failing heart.
It inhibits Na⁺/K⁺-ATPase, leading to increased intracellular Ca²⁺.
What does ARNI stand for and its function in chronic heart failure?
Angiotensin Receptor Neprilysin Inhibitor; enhances diuresis, natriuresis, and myocardial relaxation while inhibiting renin and aldosterone secretion.
It selectively blocks the AT1 receptor.
What are the effects of SGLT2 inhibitors in chronic heart failure?
- Promotes osmotic diuresis
- Decreases preload
- Lowers blood pressure
- Decreases arterial stiffness and vascular resistance
- Reduces weight and uric acid
- Improves cardiac metabolism
They help in managing heart failure symptoms.
What is the treatment approach for chronic heart failure?
Start with ACE inhibitor (or ARNI) and a β-blocker, then add MRA, SGLT2 inhibitor, and digoxin or ivabradine if still symptomatic.
This stepwise approach addresses persistent symptoms.
what does warm and dry mean?
No low perfusion and no congestion
what does warm and wet mean?
No low perfusion
Congestion at rest
What does cold and dry mean?
Low perfusion at rest
No congestion at rest
What does cold and wet mean?
Low perfusion and congestion at rest
How does digoxin work?
Inhibits the Na/K ATPase pump to increase intracellular calcium and increase contractility
