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CVS > Heart failure > Flashcards

Heart failure Flashcards

1
Q

define heart failure

A

progressive disorder caused by structural or functional abnormalities of the heart causing reduced cardiac output

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2
Q

what 2 things are the types of heart failure defined by?

A
  1. how sudden symptoms come on

2. how much blood the heart can pump out with each heart beat

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3
Q

what is the difference between chronic and acute heart failure?

A

acute: symptoms come on suddenly
chronic: symptoms been going on for a while

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4
Q

what are the symptoms of heart failure?

A 
shortness of breath
coughing/wheezing
reduced exercise tolerance
ankle swelling
fatigue
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5
Q

what are the 4 risk factors of heart failure?

A

men
smokers
diabetic patients
older ppl [risk increases with age]

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6
Q

what is the most common cause of heart failure?

A

coronary heart disease

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7
Q

what are the types of tests that are done to diagnose heart failure?

A
  • physical examination: faster than normal pulse, fluid retention, enlarged heart
  • blood tests: BNP, B type natriuretic peptide or N terminal proBtype natriuretic peptide are all raised in heart failure
  • others: ECG, chest x ray, urine tests
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8
Q

what is the non drug treatment of heart failure?

A
  • life style measures: smoking, diet, exercise
  • restrict salt to 6g daily
  • weigh daily and report weight gain of 1.5-2kg in 2 days to GP
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9
Q

what drugs can be used for heart failure?

A

AIDS BAND

amiodarone
ivabradine
digoxin
sacubitril valsartan
beta blockers
ace inhibitors/ARB 
nitrates/hydralazine
Diuretics eg loop diuretics
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10
Q

which drug classes should be completely avoided in heart failure and angina?

A

calcium channel blockers EXCEPT amlodipine

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11
Q

which patients are digoxin, hydralazine, ivabradine and nitrates reserved for , for heart failure?

A

for ppl with worsening heart failure despite other medications

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12
Q

what are mineralocorticoid receptor antagonists and can they be used in heart failure?

A

spironolactone/eplerenone

yes

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13
Q

which vaccine should be offered to heart failure patients and why?

A

influenza vaccine for protection against pneumococcal disease

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14
Q

why would you prescribe loop diuretics for heart failure?

A

to help with fluid retention and breathlessness

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15
Q

why would you stop ccb drugs in heart failure?

A

bc CCBs [except amlodipine] worsen heart failure

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16
Q

ACE inhibitors and beta blockers need to be prescribed one drug at a time in heart failure.

when would you prescribe ACE inhibitor? what for?

when would you prescribe Beta blockers?

A

ace - if pt has diabetes or fluid overload

beta blockers -if pt also has angina

17
Q

for heart failure:

what do you prescribe if a patient is intolerant to ACE inhibitors bc of side effects such as dry cough?

A

ARB

18
Q

what should be offered for heart failure if pt is intolerant to both ACE inhibitors and ARB?

what if this pt was african carribbean?

A
  • offer either nitrates or hydralazine

- if black offer nitrates

19
Q

what should be prescribed after CHRONIC HEART FAILURE has been diagnosed?

A

loop diuretic to help with fluid retention

20
Q

what is FIRST LINE TREATMENT of heart failure with REDUCED EJECTION FRACTION?

A

offer either beta blocker or ACE. then ADD them together when each drug stabilised

the choice of which drug goes first depends on pt. if the pt has angina give BB, if pt has fluid overload or diabetes, give ACE inhibitors

21
Q

if an ACE inhibitor or a beta blocker is NOT controlling heart failure with reduced ejection fraction, what can be offered next?

A

potassium sparing diuretics such as spironolactone or eplerenone

22
Q

which ‘diabetic’ drug can be used for heart failure with reduced ejection fraction? what dose?

A

dapagliflozin 10mg ONCE daily

23
Q

if symptoms of heart failure [with reduced ejection] still persist despite the ACE/ARB beta blocker and potassium sparing diuretic, what other options can you consider? [4 options]

A
  1. replace ACE/ARB with sacubitral valsartan IF ejection fraction less than 35%
  2. ADD ivabradine if pt has sinus rhythm AND heart rate more than 75 and ejection fraction less than 35%
  3. ADD digoxin if pt also has sinus rhythm
  4. consider hydralazine/nitrates for black ppl

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