Clinical Therpaeutics - Rogers

Question 1

What’s the difference between…

Left Ventricular Systolic Dysfunction (LVSD)

Diastolic Heart Faliure

Right Ventricular Systolic Dysfunction (RVSD)

Answer 1

Left Ventricular Systolic Dysfunction (LVSD) –> Heart faliure with reduced ejection fraction

Diastolic Heart Faliure –> Heart faliure with preserved ejection fraction

Right Ventricular Systolic Dysfunction (RVSD) –> Secondary to LVSD

Question 2

What is the NYHA classification of Heart Faliure?

Answer 2

Class 1 –> No limitation of physical exercise

Class 2 –> Slight limitation, comfort at rest….but normal exercise will cause symptoms

Class 3 –> Marked limitation of activity, comfort at rest…..but less than ordinary exercise causes symptoms

Class 4 –> Unable to carry out any physical activity without discomfort, symptoms at rest

Question 3

What effect do Naturetic Peptides have?

Answer 3

Atrial Naturetic Peptides (ANPs) –> Released from atrial myocytes in response to stretch

Decreases the Renin-angiotensin system

Levels increased in heart faliure

Brain Naturetic Peptides –> Released by the ventricles in response to myocardial wall stress

Increased levels (BNP and NT-proBNP) in heart faliure

Question 4

What are the treatments for Left Ventricular Systolic Dysfunction?

Answer 4

First line –> ACEi plus B-Blocker

Second Line –> Spironolactone/Epleronone, licenced ARB, hydralasine with nirate

All in combo with ACEi and B-Blocker

Third Line –> Digoxin or Ivabradine