Heart failure Flashcards
1.
Acute management of HF?
(5)
- IV loop diurets e.g. Furosemide or Bumetanide
- Oxygen 94-98%
- Vasodilators - not routinely given - may be required if concurrent MI or severe hypertension
- CPAP - if in respiratory failure
1.Opiates - previously used to improve distress/dyspnea - but may increase mortality.
Management of acute HF in patients with hypotension <85 mmHg/Cardiogenic shock
(2)
- **Inotropic agents **-
Dobutamine - cardiac inotrope used in the acute treatment of congestive heart failure, by improving cardiac output.
Used in patients with severe L. Ventricular failure - **Vasopressor agents **-
- induce vasoconstriction and elevate blood pressure
Norepinephrine - if insufficient response to inotropes and evidence of end-organ hypo perfusion
How is HF diagnosed?
BNP is a hormone produced mainly by the left ventricular myocardium in response to strain
- Patients should have a NT-proBNP blood test first line
- If ‘high; - Specialist assessment including Transthoracic echo within 2 weeks
- If ‘raised’ - Specialist assessment incl ECHO within 6 weeks
First line treatment for Heart failure
- Diuretic - Furosemide
- Ace inhibitor
- Beta-blocker
Which drug is preferred if a patient with diabetes has heart failure?
If patient has diabetes - start with an Ace inhibitor as they are renoprotective and thus beneficial
What is the drug that is indicated in Atrial fibrillation and Heart failure?
Digoxin
What is the second line therapy for Heart Failure?
- Aldosterone antagonist - Spirnolactone/Eplerenone
- SGLT-2 inhibitors e.g. Dapagliflozin, Empagliflozin
What is the third therapy for Heart Failure?
- Ivabradine
- Digoxin
- Hydralazine with nitrate
Role of Spirnolactone in HF
Indication : HF with reduced LVEF
MOA :
* Blocks aldosterone - preventing sodium and water retention in the body
* Increased excretion of sodium and water - reducing fluid retention
Benefits;
* Reduces mortality
* Improve symptoms
* Slows progression of HF
Role of Sacubitril/valsartan in HF
MOA : combination of;
1. Neprilypsin inhibitor - inhibits breaks down BNP/peptides
* Increases their vasodilator/diuretic effects
2. Valsartan : ARB blocks effect of angiotensin 2
* Improving vasodilation and reducing fluid retention
Role of Ivabradine in HF
Indic : HF with LVEF <35%
MOA : selective inhibition of ‘f’ current in SA node - reducing HR
* Slows down HR, improves diastolic filling and less oxygen consumption by myocardial muscle
* Better cardiac efficiency
What is the MOA and indication for SGLT-2 inhibitors in Heart Failure?
Indic : HF with reduced ejection fraction
MOA : Reduce glucose reabsorption and increase urinary glucose excretion
What is the indication for Ivabradine?
Left ventricular ejection fraction <35% (reduced) and symptomatic on Acei/ARBs
Which drugs have no prognostic benefit on HF?
- Furosemide/Diuretic
- Ace inhibitors and beta blockers have no effect on mortality in HF with a preserved ejection fraction
Which drugs for HF have a prognostic benefit?
- Ace inhibitor/ARB
Prognostic benefit - helps remodel the heart by reducing after load - Mineralocorticoid antagonist e.g. Spirnolactone
- Sacubritil/Valsartan
