heart failure Flashcards
what are the 3 types of heart failure and what is the most common
- left side failure - due to hypertension (commonest)
- right side failure - chronic lung disease
- bi-ventricular failure - left ventricular cause pulmonary congestion which lead to right sided failure
describe the 4 classes of heart failure symptoms
Class 1 - no symptoms during normal activity
Class 2 - comfortable at rest, normal activity
triggers symptoms
Class 3 - comfortable at rest, minor activity
trigger symptoms
Class 4 - unable to carry out any physical activity
as well as symptoms at rest
symptoms of heart failure
hypotension (tiredness,dizziness), reduced urine flow, cold peripheries, breathlessness, oedema, atrial fibrillation
Causes of left side heart failure (1) S_ D_
- Systolic dysfunction
= impaired contractility (myocardial infraction, overstretched heart, leaky valves, mitral/aortic regurgitation)
= pressure overload (uncontrolled hypeetension)
Causes of left side heart failure (2) D_ D_
Diastolic dysfunction
=reduced compliance of ventricular wall
- left ventricular hypertrophy, myocardial ischaemic
Cause of left side heart failure (3) O_ L_ V_ F_
Obstruction of left ventricular filling
= cardiac tamponade
= narrowed mitral value - mitral stenosis
what is used to identify heart failure
echocardiogram
= reduced ejection fraction
= <40%
= stroke volume is reduced, reduced exercise tolerance
treatment (pharamceutical) for heart failure
-beta blocker
-vasodilator
-venodilators
-ACE inhibitor
-K+ sparing diuretics (spironolactone)
-Digoxin
Not need to know
-loop diuretics
-angiotensin receptor
-hyperpolarisation activated cyclic nucleotide-gated channel block
-loop diuretics
name a loop diuretics, and the mechanism of action
Furosemide
-increase vasodilator
-promotes urinary excretion of Na+/Cl-, K+, H20
-reduces electrolyte reabsorption in ascending limb
excretion of 20-25% of filtered Na+
adverse effects of loop diuretics
dizziness, electrolyte imbalence, fatigue, headache, metabolic alkealosis, muscle spasms, nausea
risk of urinary retention
risk of hypovoleamia, hypotension
when are loop diuretics prescribed
- pulmonary oedema due to acute left ventricular failure
- chronic heart failure
contra-indications of loop diuretics
=anuria, drug-induced renal failure, severe hypokalaemia, severe hyponatreamia
=use lower dose in elderly
what type of administration route for loop diuretics can relief of breathlessness and reduce pre-load sooner then onset of diuresis
Intravenous
Give the drug name of nitrate+vasodilators
Hydralazine with nitrate
how does Hydralazine with nitrate
nitrates= relaxes veins (ease work on the heart)
Hydralazine = dilates arteries (lowers BP)
reduces preload and risk of pulmonary congestion, reduce after load and increase stroke volume
Hydralazine+nitrates adverse effects
-fainting, fast/pounding heart, rash, swollen joint, fever, numbness + tingling in peripheries
-Blurred vision, chest pain, hives, difficult in breathing, nausue and vomiting
-Tachycardia
if taking Hydralazine+nitrate you cant consume
Cant take alcohol, cough/cold medicine, black liquorice, herbal/chinese medicine, anti-inflammatory medicine, viagra
When are hydralazine+nitrate prescibed
if patients cant take ACE inhibitors and ARBs
if a person has black heritage
what is the mechanism of digoxin
positive inotrope which increases intracellular Ca2+, interupts Na2+ extrusion and blocks Na+/K+ pump
why would digoxin be prescribed
-supraventricular arrhythmias
-chronic atrial firbrilation
-chronic heart failure = improves symptoms but not mortality
Digoxin’s adverse effects
arrhythmias, cardiac conduction problems, cerebral impairment, diarrhoea, dizziness, nausae/vomitting, skin reaction, vision disorders
what are the risks of using digoxin
digitalis toxicity with electrolyte imbalance
what is given for heart failure with reduced cardiac function
ACE inhibitor plus beta blockers
Name the two diuretics used to treat heart failure and how they differ
Loop diuretics -furosemide
K+ sparing - spironolactone
Spironolactone doesn’t cause hypokalaemia
spironolactone is a what
mineralocorticoid receptor antagonists
