cardiac failure 2

Question 1

chronic heart failure

Answer 1

abnormality of cardiac structure or function leading to failure of the heart to failure of the heart to deliver oxygen at a rate commensurate with the requirements of the metabolising tissues

Question 2

ejection fraction

Answer 2

stroke volume divided by LVEDV.
quantification of left ventricular systolic function.
- commonest way to measure is by echocardiography.
- normal EF > 50%
- reduced EF <40%
- severely impaired EF <35%

Question 3

pharmacological management

Answer 3

• stage-dependent
• all patients with LVSD should commence an Angiotensin-converting enzyme inhibitor (ACE inhibitor) and a Beta-blocker
• all patients with pulmonary or peripheral oedema should receive a diuretic

Question 4

ACE inhibitors

Answer 4

• e.g. Enalapril, Ramipril, Lisinopril
• reduce arterial and venous vasoconstriction (reduce after- and pre-load)
• reduce salt/water retention, hence reduce circulating volume
• inhibits RAS, prevents adverse cardiac remodelling
• also used in hypertension

Question 5

ACEIs in use

Answer 5

low dose then titrate up. monitor urea/ creatinine and K+ before and during treatment.

• may cause hypotension so consider giving at night
• may cause deterioration of renal function in pre-existing renal disease
• may cause cough (10%) to build up of bradykinin
• rarely cause angio-oedema
• avoid in renovascular disease

Question 6

AT1 Receptor antagonists

Answer 6

• e.g. losartan, Valsartan, candesartan
• also known as Angiotensin receptor blockers (ARBs)
• angiotensin II acts at AT1 receptors
• AT1