2. Heart Failure HF Flashcards
What is HF
Inability to sufficiently pump blood round the body
HF
Tx
With explanation 1️⃣2️⃣3️⃣
0️⃣ Offer diuretics for congestive symptoms and fluid retention LOOP or THIAZIDE
1️⃣ACE/ARB + BB
ALT*
CI to ACE OR ARB: hydralazine + isosorbide (specialist)
If pts over 70 + mild-moderate stable HF: NEBIVOLOL
2️⃣ADD SPIRONOLACTONE
OR
EPLERENONE
In pts with LVSD after MI in mild- HF
ALT* (especially in Afro pts)
(Note: ARB plus ACE only 1st line when there is no other option available)
Replace ACE/ARB with:
Sacubtril (entresto) in pts LVEF <35%(who r taking low dose ACE OR ARB)
3️⃣ADD IVRABADINE <35% LVEF
♥️ bpm 75+
(Added to 1️⃣ and spironolactone/eplerenone
OR
DIGOXIN
(Added to SEVERE or worsening HF) to Improve symptoms, DOES NOT REDUCE MORTALITY)
HR
Tx
Basic 1️⃣2️⃣3️⃣
0️⃣ Offer diuretics for congestive symptoms and fluid retention LOOP or THIAZIDE
1️⃣ ACE/ARB +BB (nebivolol >70)
ALT↪️ HYDRALAZINE + ISOSORBIDE
2️⃣ ADD SPRIONOLACTONE/ EPLERENONE
↪️ in Afro pts
ACE+ARB (entresto) (LVEF <35%)
SACUBTRIL
To replace ACE-ARB
3️⃣ ADD to 1️⃣
IVRABADINE
OR
DIGOXIN (improves symptoms not mortality)
HR
FIRST LINE
Tx in fluid overload
ADD to Tx
LOOP diuretic (ok in severe HF/ Renal failure)
OR
ADD: THIAZIDES DIURETIC if : please
eGFR <30ml/min/1.73m2 or more
If 1 drug doesn’t work give both, still doesn’t work give:
METOLAZONE is added
ACE
Licensed in HF
5
Ramipril Captopril Enalapril Lisionopril Quinapril
ARB licensed in HF
Candesartan
Valsartan
BB
licences in HF
Bisoprolol
Carbvedilol
70+ (nebivolol)
Positive inotrope
give few examples
Digoxin Berberine Calcium Calcium sensitisers Levosimendan Catecholamines Dopamine Dobutamine Dopexamine Adrenaline (epinephrine) Isoproterenol (isoprenaline) Noradrenaline (norepinephrine) Angiotensin II Eicosanoids Prostaglandins[10] Phosphodiesterase inhibitors Enoximone Milrinone Amrinone Theophylline Glucagon Insulin
Negative inotropic drugs
Give few examples
Beta blockers Non-dihydropyridine Calcium channel blockers Diltiazem Verapamil Class IA antiarrhythmics such as
Quinidine
Procainamide
Disopyramide
Class IC antiarrhythmics such as
Flecainide
Isovoacangine Voacristine
What is an inotrope
Inotropic agents, or inotropes, are medicines that change the force of your heart’s contractions.
There are 2 kinds of inotropes: positive inotropes and negative inotropes.
Positive inotropes strengthen the force of the heartbeat.
Negative inotropes weaken the force of the heartbeat.
If ARB used with ACE
Increased risk of?
Severe
Hyperkalaemia
Hypotension
Renal impairment
If pts takes
ARB and ACE
Which supplement and which fruit to avoid ?
Potassium supplement or banana
Due to SE hyperkalamia
Blood levels of
NT-proBNP
When to refer to specialist
<400ng/L
400-2000ng/L
> 2000ng/L
Unlikely 400 or less
Refer in 6 weeks 400-2000
Refer in 2 weeks or less 2000+
HF
Symptoms
breathlessness after activity or at rest
feeling tired most of the time and finding exercise exhausting
swollen ankles and legs
HF
what could be the cause?
cardiomyopathy, a disorder of the heart muscle that causes the heart to become weak.
a congenital heart defect.
a heart attack.
heart valve disease.
certain types of arrhythmias, or irregular heart rhythms.
high blood pressure.
emphysema, a disease of the lung.
diabetes.
What drug class are
Spironolactone and Eplerenone
aldosterone antagonist
Suspected HF sue to symptoms
What is the first thing to do?
Check
Perform ECG Consider chest X-ray, blood tests -> Measure NT-proBNP urinalysis, peak flow or spirometry
Renal function
At …………?
consider lower doses or slower titration of ACEI or ARBs, MRAs, sacubitril valsartan and digoxin.
eGFR 30 to 45 ml/min/1.73 m2
HR
classes 1-4
most sever 4
class 1 – you don’t have any symptoms during normal physical activity
class 2 – you’re comfortable at rest, but normal physical activity triggers symptoms
class 3 – you’re comfortable at rest, but minor physical activity triggers symptoms
class 4 – you’re unable to carry out any physical activity without discomfort and may have symptoms even when resting
