4. Heart failure drugs

Question 1

Mr X has been diagnosed with HF. What lifestyle changes would you suggest?

Answer 1

1. Stop smoking
2. Reduce alcohol
3. Reduce salt
4. Increase aerobic exercise

Aim to increase BP.

Question 2

Mr X has been diagnosed with HF. Which 3 types of medication would you prescribe for 1st line treatment? Explain why.

Answer 2

1. ACEi or ARB
   - reduce BP by inhibiting RAAS.
2. Beta-blockers, e.g. bisoprolol, carvedilol
   - reduce HR
   - decrease SNS-mediated renin release
   - reduce inappropriate SNS activity on heart (so decrease O2 demand, inflammatory mediators and abnormal cardiac tissue remodeling)

Improve mortality and reduce symptoms.

3. Spironolactone (aldosterone antagonist) - reduces mortality:
   - inhibits heart remodelling effects (fibrosis) of aldosterone

Question 3

Mr X shows symptoms of volume overload - ascites, peripheral oedema and chronic coughing. Explain why these symptoms occur and how you would treat them.

Answer 3

i) Decreased CO… relative renal hypoperfusion… stimulates RAAS…
ii) Na+ and free water retention… increased blood volume and pressure (capacitance vessels)…
iii) fluid extravasation into tissues… oedema

Treat with loop diuretics, e.g. furosemide

• very potent diuretics
• also cause vaso and venodilation (decreased after/preload)

Question 4

If Mr X were to develop palpitations/increased HR as a result of his HF, which drug would you prescribe? How does it act?

Answer 4

IVABRADINE - acts to reduce HR by blocking funny current in SAN.

Question 5

You are concerned Mr X is at higher risk of strokes and emboli due to his HF. What drug would you prescribe?

Answer 5

Dual anti-platelet therapy: aspirin + 1 other