chronic heart failure Flashcards
What is the mainstay of treatment for HFrEF?
Quadruple therapy including:
* ACE inhibitor or sartan
* Heart failure beta blocker
* Mineralocorticoid receptor antagonist (MRA)
* Sodium-glucose co-transporter 2 (SGLT2) inhibitor
This combination is considered for all HFrEF patients unless contraindicated or not tolerated.
What is the purpose of quadruple therapy in HFrEF?
To prolong survival and reduce heart failure hospitalisations.
It is essential for managing heart failure with reduced ejection fraction.
What should be considered for patients with persistent symptomatic HFrEF despite maximum doses of standard medications?
Substitution of ACE inhibitor or sartan with an angiotensin receptor neprilysin inhibitor (ARNI) may be considered with or without an MRA.
A washout period of at least 36 hours is required when replacing an ACE inhibitor with an ARNI.
What is the recommended approach for introducing new medications in heart failure treatment?
Introduce at a low dose and slowly increase to target or maximum tolerated dose, not exceeding published doses in the Australian Medicines Handbook.
Starting and target doses can be found in clinical guidelines.
What recent guidance has been provided regarding SGLT2 inhibitors?
SGLT2 inhibitors (dapagliflozin or empagliflozin) are PBS subsidised for symptomatic HFrEF in patients with LVEF ≤ 40% as add-on therapy.
This is alongside optimal standard chronic heart failure treatment.
What type of diuretics are generally preferred for acute heart failure treatment?
Loop diuretics.
They can be added to treatment at any stage to help relieve symptoms of fluid retention and congestion. use the lowest effective dose and case when symptoms resolve
What should be monitored when using diuretics in heart failure patients?
Use the lowest effective dose and cease when symptoms have resolved. Diuretic dose may be reduced if euvolaemic.
This should be done unless it has previously exacerbated symptoms.
Which non-prescription medicines can exacerbate heart failure symptoms?
NSAIDs, such as ibuprofen.
Discuss with patients how to avoid these medications.
What dietary restrictions should be discussed with heart failure patients?
Salt and fluid restriction.
Be prepared to discuss barriers to complying with these restrictions.
What treatment may coronary artery disease require?
Revascularisation and drug therapy.
What comorbidities are often associated with diabetes mellitus in heart failure patients?
- Elevated BP
- Kidney disease
- Coronary artery disease
How can excess alcohol intake affect heart failure?
It can cause heart failure and may respond to thiamine supplementation.
What recreational stimulant drugs may be suggested by unexplained left ventricular dysfunction?
- Cocaine
- Amphetamines
What are some cardiomyopathies that may be prevented by certain therapies?
- Disease-specific therapies for cardiac amyloidosis
- Venesection for haemochromatosis
- Iron chelation therapy for thalassaemia
- Echocardiographic monitoring and dose adjustment for chemotherapy associated with cardiotoxicity
What should be managed to alleviate cor pulmonale in heart failure patients?
Chronic lung disease.
What condition may present with isolated right ventricular failure?
Pulmonary embolism.
What are less common causes of heart failure?
- Inherited cardiomyopathies (dilated and hypertrophic)
- Constrictive pericarditis
- Other metabolic causes (hypothyroidism, phaeochromocytoma)
- Heavy metal toxicity (cobalt)
- Radiation therapy
- Nutritional deficiencies
- Myocarditis
- Infiltrative cardiomyopathies
causes of heart failure
high blood pressure
coronary artery diease
diabetes
arrhythmia
excess alcohol intake
use of recreational stimulants
cardiomyopathies
valvular heart disease
hyperthyroidism
chronic lung disease
pulmonary embolism
pericardial effusion
