Heart failure Flashcards
define heart failure
progressive disorder caused by structural or functional abnormalities of the heart causing reduced cardiac output
what 2 things are the types of heart failure defined by?
- how sudden symptoms come on
2. how much blood the heart can pump out with each heart beat
what is the difference between chronic and acute heart failure?
acute: symptoms come on suddenly
chronic: symptoms been going on for a while
what are the symptoms of heart failure?
shortness of breath coughing/wheezing reduced exercise tolerance ankle swelling fatigue
what are the 4 risk factors of heart failure?
men
smokers
diabetic patients
older ppl [risk increases with age]
what is the most common cause of heart failure?
coronary heart disease
what are the types of tests that are done to diagnose heart failure?
- 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
what is the non drug treatment of heart failure?
- 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
what drugs can be used for heart failure?
AIDS BAND
amiodarone ivabradine digoxin sacubitril valsartan beta blockers ace inhibitors/ARB nitrates/hydralazine Diuretics eg loop diuretics
which drug classes should be completely avoided in heart failure and angina?
calcium channel blockers EXCEPT amlodipine
which patients are digoxin, hydralazine, ivabradine and nitrates reserved for , for heart failure?
for ppl with worsening heart failure despite other medications
what are mineralocorticoid receptor antagonists and can they be used in heart failure?
spironolactone/eplerenone
yes
which vaccine should be offered to heart failure patients and why?
influenza vaccine for protection against pneumococcal disease
why would you prescribe loop diuretics for heart failure?
to help with fluid retention and breathlessness
why would you stop ccb drugs in heart failure?
bc CCBs [except amlodipine] worsen heart failure
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?
ace - if pt has diabetes or fluid overload
beta blockers -if pt also has angina
for heart failure:
what do you prescribe if a patient is intolerant to ACE inhibitors bc of side effects such as dry cough?
ARB
what should be offered for heart failure if pt is intolerant to both ACE inhibitors and ARB?
what if this pt was african carribbean?
- offer either nitrates or hydralazine
- if black offer nitrates
what should be prescribed after CHRONIC HEART FAILURE has been diagnosed?
loop diuretic to help with fluid retention
what is FIRST LINE TREATMENT of heart failure with REDUCED EJECTION FRACTION?
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
if an ACE inhibitor or a beta blocker is NOT controlling heart failure with reduced ejection fraction, what can be offered next?
potassium sparing diuretics such as spironolactone or eplerenone
which ‘diabetic’ drug can be used for heart failure with reduced ejection fraction? what dose?
dapagliflozin 10mg ONCE daily
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]
- replace ACE/ARB with sacubitral valsartan IF ejection fraction less than 35%
- ADD ivabradine if pt has sinus rhythm AND heart rate more than 75 and ejection fraction less than 35%
- ADD digoxin if pt also has sinus rhythm
- consider hydralazine/nitrates for black ppl
