Cardiovascular Part 3 Flashcards
What is reduced ejection fraction heart failure?
The left ventricle of the heart loses its ability to contract normally and presents with less than 40% ejection fraction
What is preserved ejection fraction heart failure?
The left ventricle uses its ability to relax normally = ejection fraction is normal or mildly reduced
What is the maximum salt intake in heart failure?
6g
Salt substitutes containing potassium should be avoided - risk of hyperkalaemia
What drugs should be avoided in reduced ejection heart failure?
Rate-limiting CCB and short-acting dihydropyridines (nifedipine or nicardipine)
These drugs reduce cardiac contractility
Which kind of diuretic is usually recommended in heart failure?
Loop diuretics
- relief of breathlessness and oedema
When should thiazide diuretics be avoided in renal impairment?
eGFR <30ml/min
Which beta blockers are licensed for heart failure?
Bisoprolol
Carvedilol
Nebivolol
Which ARBs are licensed for heart failure?
Losartan
Candesartan
Valsartan
What is the treatment pathway for heart failure?
Loop diuretic for symptomatic relief
1st: ACEi/ARB or BB
2nd: Spironolactone/ eplerenone (add-on) - unless contraindicated due to hyperkalemia or renal impairment
If ACE/ARB not tolerated: under specialist advice, hydralazine combined with a nitrate can be given considered if pt intolerant of ACEi/ARB
If symptoms persist, specialist should consider: SGLT2 OR replace ACE with sacubitril valsartan OR digoxin in sinus rhythm OR ivabradine
How do you treat a patient in sinus rhythm with worsening or severe HF despite optimal treatment?
Add-on therapy of digoxin
Also, consider an anticoagulant in patients with a history of thromboembolism, left ventricular aneurysm or intracardiac thrombus
Which beta blocker is least likely to cause bronchospams?
Atenolol
Which beta blockers are cardioselective?
B A MAN
Bisoprolol
Atenolol
Metoprolol
Acebutolol (to a lesser extent)
Nebivolol
These have a lesser effect on airway resistance but are not completely free from bronchospasm as a side effect
What is the prescribing pathway for a pregnant woman with hypertension?
1st line: Labetalol
2nd line: nifedipine
3rd line: methyldopa
What are the BP targets with patients with diabetes?
T2DM - <140/90
T1DM - <135/85
If T1/2DM with complications- <130/80
What are the risks of digoxin toxicity?
HypOkalaemia
HypOmagnesaemia
HyERrcalcaemia
Hypoxia
Renal impairment
What are the signs of digoxin toxicity?
GI signs: N/V, abdominal pain, diarrhoea
Metabolic signs: hyperkalemia
CVS signs: bradycardia, hypotension
CNS signs: lethargy, confusion
Eyes: blurred, eye vision
Which drugs interact with digoxin?
CRASED
CCBs
Rifampicin
Amiodarone
St Johns Wort
Erythromycin
Diuretics
What antibiotics interact with warfarin?
Co-trimoxazole
Metronidazole
Macrolides
Fluroquinolones
Rifampicin
What are the requirements for ivabradine to be considered for HF?
In sinus rhythm
HR >75bpm
Ejection fraction <35%
What antifungals interact with warfarin?
Miconazole
Fluconazole
