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Heart FIlure > Cardiac Failure 2: Clinical Management > Flashcards

Cardiac Failure 2: Clinical Management Flashcards

1
Q

What should all patients with LVSD receive?

A

Angiotensin-converting enzyme inhibitor

Beta blocker

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2
Q

What should all ps with oedema receive?

A

Diuretic

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3
Q

Example of ACEI

A

Ramipril

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4
Q

Action of ACEIs

A

Inhibits ACE which converts angiotensin I to angiotensin II in RAA system

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5
Q

Effect of ACEIs

A

Reduce arterial and venous vasoconstriction (reduce after- and pre-load)
Reduce salt/water retention, hence reduce circulating volume

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6
Q

How to use ACEIs and when?

A

Low dose
Monitor urea/creative and K+ before and during treatment
Hypertension
Inhibit RAA system to prevent cardiac remodelling, improves function of myocyte

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7
Q

Side effects of ACEIs

A

Severe hypotension
Deterioration of renal function in pre-existing renal disease
10% have dry cough

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8
Q

When should ACEIs not be used?

And why?

A

Renovascular disease

Substantial drop in BP, kidney under perfused, damage to kidney

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9
Q

What happens in kidney when renal blood flow is impaired?

A

Renin produced to maintain blood pressure

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10
Q

What is bilateral renal artery stenosis ?

A

Plaque in both arteries of kidneys

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11
Q

Action of AT1 receptor antagonists

A

Block action of angiotensin II by blocking AT I receptors

Therefore no vasoconstriction and no aldosterone produced

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12
Q

Example of AT1 receptor antagonists

A

Iosartan

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13
Q

Why might AT 1 receptor antagonists be used instead of ACEIs?

A

Less likely to give cough

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14
Q

Example of beta blocker

Effect

A

Bisoprolol
Beta 1 selective
Reduce disease progression, symptoms and mortality

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15
Q

Use of beta blockers

A

Use in stable, moderate failure
care needed for COPD
Failure related with ischaemia - useful

Start with low dose

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16
Q

Effect of beta blocker

A

Reduce sympathetic stimulation, heart rate and O2 consumption
Antiarrhythmic: will control rate in atrial fibrillation
Oppose the neurohormonal activation which leads to myocyte dysfunction
Symptoms may get worse at first

17
Q

Most common diuretics and effect

A

Loop diuretics eg. Furosemide
Very powerful
Reduce circulatory volume and oedema

18
Q

What can loop diuretics cause

A

Hypokalaemia - reduction of K+ on the blood

Especially thiazides

19
Q

What do spironolactones do

A

Aldosterone receptor antagonists

Reverse LV hypertrophy

20
Q

Action of digoxin

A

Positive inotrope by inhibiting Na+/K+ ATPase
Na+ accumulates in myocyte, pushed out, exchanged with Ca2+ - compensation
Leads to increased contractility

21
Q

Why does Ca2+ build up due to digoxin?

A

Na/Ca exchange compensation

In repolarisation, Na gradient is reduced which reduces efflux of Ca

22
Q

What does digoxin do in AF?

A

Slows heart rate, improving cardiac filling

Impairs AV conduction and increases vagal activity

23
Q

Other specialist drugs

A

Ivebradine

Sacubitril valsartan

24
Q

Ivabradine effect

A

Inhibits funny current

Used with ACEI/beta blocker and MRA

25
Q

Sacubitril valsartan effect

A

Neorikysin inhibitor

Endopeotidase inhibitor

26
Q

What is prescribed with main heart failure drugs?

A

Vasodilator - nitrates, prazosin, hydralazine

Positive inotropes - final approach, phosphodiesterase inhibitors, amines

27
Q

What to monitor?

A

Renal function
Use of ACEi – care in mild-moderate failure, contraindicated in renovascular disease
Potassium
Hypokalaemia a major problem [aldosterone]
Side effect of thiazides/loop diuretics
Enhances effects of digoxin

28
Q

When is there a serious possibility of hyperkalaemia?

A

NB serious possibility of hyperkalaemia with ACEi if used with a K+ sparing diuretic

29
Q

Why is monitoring renal function important ?

A

Elderly - GFR may be impaired

Important for drug handling, dose of digoxin

30
Q

Why is digoxin monitored?

A 
Digoxin toxicity
Major problem 
Narrow therapeutic window
Digoxin – anorexia, nausea (suggest dose too high), visual disturbances, diarrhoea
Digoxin in AF, monitor pulse (>60bpm)
31
Q

When is an ATRA used?

A

When LV dysfunction p has a cough

Heart FIlure (9 decks)

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