CVS - Congestive Heart Failure Flashcards
Heart failure can be divided into
High output HF - increased tissue demand
Low output HF - Heart not adequately pumping
Which conditions can cause High output HF
Thyrotoxicosis
Severe anaemia
Left ventricular failure can be characterized by
Pulmonary edema - Dyspnea
Right ventricular failure can be characterized by
Elevated JVP
Congestive Hepatomegaly
Aim of treatment in Acute CHF
Congestion - remove the fluid
Heart not pumping - Inotropics (increases contractility)
Preferred group of diuretics in case of Acute CHF
Loop diuretics - Furosemide
Common side effects of Loop diuretics and Thiazides
Hypokalemia
Hypomagnesemia
Hyponatremia
Metabolic alkalosis
Hyperglycemia
Hyperlipidemia
Hyperuricemia
Difference in sire effects of Loop diuretics and Thiazides
Loop diuretics - Hypocalcemia
Thiazides - Hypercalcemia
Inotropics used in Acute CHF
Beta 1 agonist
PDE-3 Inhibitors
Beta 1 agonist used in Acute CHF
Dopamine
Dobutamine
Isoprenaline
Nor adrenaline
PDE-3 inhibitors used in Acute CHF
InAmrinone
Milrinone
Increases cAMP in both heart(Inotropic) and BV(Vasodilation)
Which drugs are termed as Inodilators and DOC in patient with right sided Heart failure
PDE-3 Inhibitors - InAmrinone, Milrinone
Aim of treatment in Chronic CHF
Decrease work of heart
Remove the fluid
To reverse LVH or cardiac remodeling
Drugs used to decrease work of heart in Chronic CHF
Vasodilators
Vasodilator which only acts on veins
Nitrates
Vasodilator which only acts on arteries
Hydralazine
Vasodilators which acts on both Veins and arteries
Sodium Nitroprusside
ACE inhibitors
ARBs
Drugs used to remove fluid in case of Chronic CHF
Loop diuretics
Drugs used to reverse Cardiac modeling or to decrease Mortality
Beta blockers
ACE inhibitors
ARBs
Aldosterone Antagonists
Beta blockers which are commonly used in Chronic CHF
Start with low dose
Carvedilol - MC
Metoprolol
Bisoprolol
ACE inhibitors
‘PRIL’
Captopril
Lisinopril
Enalapril
Ramipril
Perindopril
Moexipril
Trandolapril
ACE Inhibitors can increase Bradykinin levels and can cause side effects like
Dry cough
Angioedema
Characteristics of ACE inhibitors
C - Cough
A - Angioedema
P - Prodrugs
T - Taste alternation (Dysgeusia )
O - Orthostatic hypotension
P - Pregnancy avoid
R - Renal artery stenosis avoid
I - increased K(Hyperkalemia) avoid
L - lowers risk of diabetic nephropathy - preferred in diabetics
Which ACE inhibitors are not Prodrugs
Captopril
Lisinopril
Angiotensin receptor Blockers
‘Sartan”
Valsartan
Losartan
Telmisartan
Irbesartan
Eprosartan
Candesartan
Difference between ACE inhibitors and ARBs
In ARBs - No cough or Angioedema as side effect
Are not Prodrugs
Which ARBs decreases uric acid levels
Losartan
Which ARB can decrease insulin resistance by stimulating PPAR-alpha
Telmisartan
Aldosterone Antagonist used in Acute CHF
Spironolactone - Potassium sparing diuretics
Decreases Na+ and H20
Increase K+ and H+
Common side effect of Spironolactone
Gynecomastia
Oral Inotropics that can be used in Chronic CHF
Cardiac glycosides - Digoxin
Cardiac glycosides directly works on
Ventricular muscles
Digoxin works by blocking
Na+-KA ATPase pump - increasing Ca2+ levels - leads to increased contractility
Digoxin have which 2 actions
Increases contractility by acting on ventricular muscles
Vagomimetic action - decreases HR and conduction
Due to Vagomimetic action, Digoxin can be given in which condition
Atrial fibrillation
Digoxin is contraindicated in
Renal failure
Side effects of Digoxin
1) Nausea and Vomiting - MC
2)Arrythmia - MC - ventricular bigeminy
Most specific - Non paroxysmal Atrial tachycardia with AV block
3) Xanthopsia (Yellow vision)
4) Gynaecomastia
Which drugs can cause Gynecomastia as a side effect
D - Digoxin
I
S - Spironolactone
C - Cimetidine
K - Ketoconazole
O - oestrogens
Which factors increases chances of Digoxin toxicity
Electrolyte imbalance
Drugs
Diseases
Which electrolytes imbalances can cause Digoxin toxicity
Hypokalemia
Hypomagnesemia
Hypercalcemia
Which drugs increases the risk of Digoxin toxicity
Quinidine
Verapamil
Amiodarone
Thiazides
Which disease increases the risk of Digoxin toxicity
Renal failure
Liver failure in case of Digitoxin
Treatment of Digoxin toxicity
Correct interactions if any
Antiarrhythmic - Lignocaine
Digibind
DOC in Digoxin induced ventricular arrythmias
Lignocaine
Bradycardiac agent that can be used in Chronic CHF
Ivabradine
Actions of BNP(Brain natriuretic peptide)
Decreases Sodium (Sodium loss in urine)
Powerful vasodilators
BNPs are metabolized by
Neprilysin
Exogenous BNP that can be used in CHF
Nesiritide - not orally effective and Very short acting
Neprilysin inhibitors used in CHF
Sacubitril
Ecadotril
Vasopeptidase inhibitors used in CHF
ACE inhibitors + Neprilysin
Omapatrilat
Sampatrilat
Most commonly used Angiotensin receptor Neprilysin inhibitors (ARNI)
Valsartan+ Sacubitril
Vasopressin receptors antagonist acts on
V1 receptor - Vasoconstriction
V2 receptor - decrease urine
Vasopressin receptors antagonist drugs
Conivaptan - iv
Tolvaptan - oral - Approved in autosomal dominant adult polycystic kidney disease
