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Therapeutics > Chronic Heart Failure > Flashcards

Chronic Heart Failure Flashcards

1
Q

Heart failure may be preciptated by

A

Pregnancy

Anaemia

Hyper&Hypothyroidism

Fluid retaining drugs: Glucocorticoids, NSAIDs

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2
Q

Systems involvde in neurohormonal adaptation to HF

A
  • SNS
  • RAAS
  • ADH
  • ANP - To Promote Sodium loss
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3
Q

Consequences of Neurohormonal adaptation to HF

A
  • Increased afterload
  • Incr circulating volume (Pre & afterload)
  • Incr resistance will cause impaired renal function, more salt/water retention and further RAAS activation
  • Vicious cycle develops impairing pump acvitity
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4
Q

LHF Cause & Consequence

A
  • Often 20 to hypertension
  • Poor output will lead to increasede in left atrial /pulmonary venous pressure with pulmonary oedema
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5
Q

Causes of RHF

A
  • Lung Disease (cor pulmonale)
  • Pulmonary valvular stenosis
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6
Q

Causes of biventricular failure

A
  • Disease (e.g. IHD affecst both ventricels)
  • LV failure leads to pulmonary congestion, which may lead to RV failure
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7
Q

LV failure S&S

A

Pulmonary oeodema

  • Dyspnea
  • Cough?
  • Oorthopnea
  • Insipiritory crackles
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8
Q

RV failure S&S

A
  • Raised venuos pressure
  • Raised VP
  • Enlarged liver
  • Oedema; ankles
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9
Q

Diagnosing HF

A
  • Symptoms + Exminatin
    • Confirmed by Echo: Ejectin fractin <45%
  • BNP levels mya be diagnostic
  • CXR: Cardiomegaly, PO, Kerely lines
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10
Q

Treatment aims in AF

A

Causes stasis of blood; risk of thrombi, TIA etc

  • Thromboembolism prophylaxis: warfarin or Aspirin
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11
Q

Pharmacological management of HF

A
  • Stage dependent
  • All with LV systolic dysfunction:ACEI
  • All w/ oedema: diuretic
  • BB in first-line in moderate/stable heart failure
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12
Q

ACEI MOA in HF

A

Enalapril, Lisinopril, Ramipril

  • Reduce arterial and venoous vasoconstriction
    • Reducing after & preload
  • Reduce Salt/water retnetiom; reduce circulating volume
  • Inhibit RAAS, so oppose maladaption and remodelling
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13
Q

How to prescribe ACEis

A
  • Low dose, titrate up, may exceed max dose
  • DO NOT USE WITH NSAIDS
  • Monitor: urea/creatinine, Potassium
  • Avoid in hypotension <100 systolic

May cause severe hypo; withdraw for few days, give at night

May further deteriorate renal function

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14
Q

AT1 MOA, Indicationos

A

Candesartan, Losartan

  • oppose ATII action at AT1 receptor
  • Equakly effective as ACI
    • No cough
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15
Q

When/which diuretics too use in HF

A
  • Thiazides: Used in mild filaure or the elderly
  • Loops: In pulmonary oedema

Reduce circulating volume = reduced Pre& after

Also vasodilate, reducing preload

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16
Q

Side effects of diuretics

A

Thiazides/loops may cause HYPOkalaemia; less of a problem when used with ACEi(cause HYPER)

17
Q

Role of BBs in HF

A

Reduce diesease proogression, sypmtoms and mortality

  • Reduce sympathetic stimulation, HR, and O2 consumption
  • Also controls AF rate
  • Oppose Neurohormonal adpatastions that cause myocyte damage
  • Especially useful when there is ischamiea
  • Start low, work up. may get worse first
  • May be used in caution with COPD
18
Q

Role of spironolactone in HF

A
  • Aldosterone receptor antagonist
  • Reduced LV hypertrophy
  • Low dose 25mg reduced mortality 35%
19
Q

Digoxin MOA in HF

A
  • Inhibits Na/KATPase. NA accumulates in myocytes, exchanged with Ca; increased contractility
  • Imapirs AV conduction and increases vagal actviirty
    • this block and brady is useful in HF with AF

CONTRAINDICATED IN CONCURRENT HEART BLOCK R BRADYCARDIA. So generally reserved for HF with AF. Titrate so HR >60

20
Q

Renal function monitoring in HF drugs

A
  • Digoxin reduced in renal impairment, due to being “/rds renally excreted
  • Thiazides ineffective in renal failure
  • ACEIs; used with care in mild-moderate failure but monitored
    • Contraindicated in renovascular disease(stenosis)
21
Q

Potassium considerations in HF management

A

Hypokalaemia from thiazides/loops

  • Enhances effect of digoxin
  • Seriours possibility of HYPERkalaemia if ACEi used with K+ sparing diuretic
22
Q

Digoxin toxicity in HF

A

Narrow therapeutic window

  • Anorexia and nausea suggest too high dose + visual disturbances, diarrhoea
  • monitor HR >60 in AF
23
Q

Treatment algorithm in HF

A

Therapeutics (17 decks)

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