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Cardiovascular > Heart failure > Flashcards

Heart failure Flashcards

1
Q

What are the top 2 causes of death globally?

A

Ischaemic heart disease and stroke are top 2

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2
Q

How is cardiovascular disease geographically distributed?

A

Countries of lower income have a higher death rate

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3
Q

Risk factors of CVD – Modifiable

A
  • Hypertension – /
  • Hypercholesterolaemia – /
  • Diabetes mellitus - U
  • Obesity – U
  • Exercise
  • Smoking
  • Diet
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4
Q

Risk factors of CVD – Non-modifiable

A
  • Age
  • Ethnicity
  • Gender
  • Family history
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5
Q

What does CVD risk factors increase?

A
  • CVD
  • Ischaemic heart disease – heart attack
  • Heart failure
  • Cerebrovascular accidents (Strokes)
  • Renal failure
  • Aortic disease
  • Peripheral arterial disease (reduced blood to legs)
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6
Q

What is left heart failure?

A

• Fluid build-up in lungs – leading to pulmonary oedema

Symptoms:
• Breathlessness and cough + tiredness

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7
Q

What is right heart failure?

A

• Fluid build-up in body – leading to peripheral oedema

Symptoms:
• Heavy painful legs + difficulty walking + tiredness

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8
Q

current heart failure treatments - lighten the load

A

Use diuretics

• Helps us lose salt and water through kidneys so less volume

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9
Q

current heart failure treatments Make the task easier

A

ACE inhibitors/angiotensin II blockers or aldosterone antagonists
• ACE inhibitors prevent an enzyme in the body from producing angiotensin II, a substance that narrows blood vessels

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10
Q

current heart failure treatments Slow down the heart

A

Beta-blockers

• Slow down the heart by blocking the action of adrenaline

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11
Q

current heart failure treatments Make the heart pump harder

A

Digoxin

• Increases the force of myocardial contraction

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12
Q

What are the limitations of current therapy?

A

Despite improvements in life expectancy with the use of ACEi/ARB and beta blockers the overall prognosis is still POOR

Side effects risk:
• Hypotension
• Impact on kidneys/electrolytes

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13
Q

What are the main therapies for heart problems?

A
  • Beta blockers – target sympathetic nervous system
  • The Renin-Angiotensin-Aldosterone System (RAAS)
  • A hormone system within the body that is essential for the regulation of blood pressure and fluid balance
  • The system is mainly comprised of the three hormones renin, angiotensin II and aldosterone.
  • Natriuretic peptides target the NP receptors
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14
Q

What are natriuretic peptides

A
  • When there is a strain on the heart – the heart tries to reduce this
  • It uses natriuretic peptides
  • It tries to reduce salt in the blood (natriuresis) by excreting salt in the urine through the action of the kidneys

NP also reduces things like:
• Blood pressure
• Aldosterone – can cause high BP
• Vasopressin – regulated body fluid (stimulated water reabsorption)

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15
Q

What is neprilysin?

A

It inactivates natriuretic peptides

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16
Q

What is ARNI?

A
  • Angiotensin receptor neprilysin inhibitor

* Blocks the effects of angiotensin 2 and neprilysin

17
Q

What is Entresto?

A NEW OPTION

A
  • In 2010
  • Combined angiotensin receptor blockade (valsartan)
  • And neprilysin inhibition (sacubitril)
  • Still aimed to reduce the effect of excess RAAS system
  • Potentiate beneficial effects of natriuretic peptides
18
Q

Difference between entresto and omapatrilat?

A
  • Omapatrilat has ACE inhibitor – lowers blood pressure by preventing production of angiotensin 2
  • Entresto has angiotensin receptor blockers which reduce the action of angiotensin 2
19
Q

Why is entresto better?

A

• Because ACE inhibitors from omapatrilat also work on bradykinin which can cause angioedema

20
Q

Clinical trials for entresto

A

• Showed a reduction in death and hospitalisation

21
Q

What is OMAPATRILAT – 1990s

A
  • In the 1990s a Combined ACE inhibitor and neprilysin inhibitor was made
  • Aimed to reduce the effect of excess RAAS system
  • Potentiate beneficial effects of natriuretic peptides
22
Q

Omapatrilat clinical trial data

A
  • Clinical trials showed no significant decrease in death rate
  • It did show a big reduction in blood pressure however
23
Q

What is Ivabradine

A NEW OPTION •

A

Slows the heart down

• Inhibition of the I channel (funny current) in the sinus node (where the electrical current starts)

24
Q

Clinical trial data on ivabradine

A
  • Clinical trials have been studied
  • Ivabradine tested on patients with severe heart failure already taking a ACEi, ARB or beta blocker
  • Ivabradine is useful in reducing death if heart rate >70 despite full dose of beta-blockers
25
Q

What are SGLT2 inhibitors

A NEW OPTION

A

Canagliflozin, dapagliflozin, empagliflozin
• Lighten the load
• Inhibit glucose reabsorption
• Has diuretic effect – decrease volume

26
Q

What is Omecamtiv mecarbil

A NEW OPTION

A
  • Proposed to increase myocardial systolic function
  • Selective cardiac myosin activator
  • Activates myocardial ATPase and improves energy utilisation (activates cardiac myosin and augments the speed of ATP hydrolysis)
  • Enhances myosin cross-bridge formation and duration
  • Improves cardiac muscle contraction
27
Q

Omecamtiv clinical trials

A
  • Small phase 3 studies
  • Small reduction in CV death or admission
  • No effect on CV deaths alone

Cardiovascular (4 decks)

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