238 HF Flashcards
Which 2 drugs should be prescribed asap following Dx of HF?
ACEI
Beta blocker
Which drug should be added into ACEI and beta blockers treatment for HF?
Spirinolactone
What should be considered before starting Spirinolactone?
Blood pressure - causes drop
At which level of LVEF should ACEI be started in HF?
Moderate LV dysfunction ie LVEF less than 45%
What is the main adverse effect of ACEI?
Cough caused by build up of bradykinin
Which other enzyme in the RAAs is active even when ACEI are in situ?
Chymase
Which ACEI is used in paeds?
Captopril
Which ACEI is a non-peptide antagonist?
Captopril
Name 2 C/I of ACEI
5 listed
Pregnancy Bilateral renal artery stenosis Severe AS, MS, LVOT Hx of idiopathic/hereditary agioedema Creat >220
Which 2 drugs are used in HF to relieve symptoms?
Diuretics
Digoxin
What type of drug is Candesartan?
Angiotensin 2 receptor blocker
Which 2 cardiac drugs can cause gyneacomastia?
Spironolactone
Digoxin
What is the alternative to spironolactone and causes less gyneacomastia?
Emplerenone
Name 2 C/I of beta blockers
6 listed
Asthma Cardiac condition defects Severe HF Severe peripheral vascular disease Raynauds Unopposed pheochromocytoma
Which beta blocker is used in pregnancy?
Labetolol
Which drug inhibits the I (f) channel to decrease HR in sinus rhythm?
Ivabradine
Phosphenes (flashing lights) are a side effect of which drug?
Ivabradine
What is the only drugs which have evidence to support treatment in diastolic HF?
Diuretics
What does pulmonary venous congestion lead to?
Left ventricular failure
What is does systemic venous congestion cause?
Right ventricular failure
Name 3 S+S of LHF
Dyspnoea
Orthopnoea
PND
Name 3 S+S of RHF
4 listed
Peripheral oedema
Elevated JVP
Hepatomegaly
Ascites
Name 4 of the commonest causes of HF
6 listed
IHD HTN Valvular heart disease Cardiomyopathy Toxic DM
What type of heart failure is caused by:
- COPD
- Pulmonary HTN (PE)
- ASD/VSD
- Chronic valvular heart disease
Right heart failure
What is cardiac cachexia?
W/L and anorexia commonly seen in HF
What do these signs indicate?
- Displaced apex beat
- Tachycardia
- PSM
- Basal inspiratory crackles
Left ventricular failure
What is diastolic HF?
- HF with preserved ejection fraction
- Increased LV wall thickness with diastolic dysfunction
What type of HF (high output/low output) do the following cause?
- Anaemia
- Thyrotoxicosis
- Liver failure
- Septicaemia
High output
What is HF-PEF (HF with preserved ejection fraction) associated with?
- CAD, HTN, DM
- HTN and AF
2
What percentage of people who are hospitalised due to HF are readmitted/dead within 1 year?
40%
Name 4 features you would see on a CXR of a pt with HF
- Cardiomegaly
- Pulmonary oedema
- Pleural effusions
- Kerley B lines
- Pulmonary venous congestion
Which investigation would be useful for a sensitive and specific prediction of CAD than a ETT?
Perfusion scintigraphy
Why should alcohol be avoided in HF?
Negatively inotropic
Raises BP and arrythmogenic
What is CRT-P
Cardiac resynchronisation therapy - pacemaker. Resynchronises inter and intraventricular contraction
What is a CRT-D?
Cardiac resynchronisation therapy - defibrillator
Why are opiates useful in the treatment of acute HF?
Useful in pulmonary oedema to relieve anxiety and distress due to dyspnoea
Which anti-emetic should be used in conjunction with diamorphine during acute HF?
Metoclopromide - don’t use cyclizine as causes vasoconstriction
What is nesiritide?
Human BNP - vasodilator to reduce dyspnoea
