Heart failure Flashcards
What should all patients with left ventricular systolic dysfunction receive
ACEi and a beta blocker
What should all patiets with oedema get
diuretics
Which drugs can worsen heart failure
Rate limiting calcium channel inhibitors
NSAIDS
Pioglitazone (anti diabetic)
(Dihydropyridines safe)
Which CCI are safe in HF
Dihydropyridines
Mode of action of ACEi
Reduce arterial and venous vasoconstriction (reduce after and pre-load)
Reduce salt/water retention hence reduce circulating volume
How to prescribe and monitor ACEI
Low dose then titrate up
Monitor eGFR and K+ before and during treatment
What may ACEi cause
Severe hypotension (give at night)
Cause deterioration of renal function in pre-existing renal disease
Cough
When should ACEi be avoided
Renovascular disease
Mode of action of AT1 receptor antagonists
Angiotensin 2 acts at AT1 receptors. AT1 receptor antagonists block the action of a2
when are ATRA used
Alternative to ACEi
Why are beta blockers used
Reduce disease progression, symptoms and mortality
What selectivity do beta blockers have
Beta1 selective
Mode of action of beta blockers
Oppose the neurohormonal activation which leads to myocyte dysfunction
What other roles do beta blockers have
Control HR in atrial fib
Useful in failure associated with ischaemia
How should you prescribe beta blockers
Start with a low dose
Symptoms may get worse at 1st
Monitor BP
What may thiazides and loop diuretics cause and how to monitor
hypokalaemia nd renal function
K+ before and during treatment
What to use for emergency relief of pulmonary oedema
I.V furosemide
Mode of action of eplerenone
Aldosterone (mineralocorticoid) receptor antagonist
Opposes cardiac fibrosis
Risk of using eplerenone
Hyperkalaemia (increased with ACEi/AT1 receptor antagonist
Mode of action of digoxin
+ve inotrope (increase force of contraction) by inhibiting Na-k+ ATPase, Na+ accumulates in myocytes, exchanged with Ca2+ leading to increased contractility
How is digoxin used in AF
Impairs AV conduction and increases vagal activity
The heart block and bradycardia is beneficial in HF with AF
-Slowing the heart improves cardiac filling
Action of sacubitril
Neprilysin (NEP) inhibitor
- Endopeptidase inhibitor
- Enzyme breaks down natriuretic peptides and bradykinin
(therefore its aim is to prevent breakdown of ANP, BNP and bradykinin)
Mode of action of valsartan
AT1 receptor antagonist
When is the risk of hyperkalaemia increased if
ACEi used with a K+ sparing diuretic
What should the pulse be maintained at if using digoxin
> 60bpm
First line treatment
ACEi/ B blocker
Or ATRA if cough
Second line treatment
Aldosterone antagonist or ARB or Hydralazine plus nitrate
Fourth line treatment
if AF- digoxin
If sinus rhythm- ivabradine
