Heart failure

Question 1

Name the 1st line drugs for heart failure

Answer 1

1. ACE inhibitors
2. ARBs
3. Beta blockers
4. Loop diuretics
5. Aldosterone receptor antagonists
6. Hydralazine
7. Ivabradine
8. Nitrates (nitroglycerin & isosorbide dinitrate)
9. ARNI: sacubitril/valsartan

Question 2

What happens to the heart when it fails?

Answer 2

Reduced cardiac output

In response, the body activates 2 compensatory mechanisms.
1. Sympathetic activation
- Increase HR
- Vasoconstriction

2. Activation of RAAS
   - Increase sodium and water retention
   - Increase blood volume & hence pressure

Question 3

What is the MOA of ARNI: sacubitril/valsartan?

Answer 3

Sacubitril is a neprilysin inhibitor. Neprilysin breaks down natriuretic peptides but also cleaves Ang II, activating RAAS.

Hence valsartan, an ARB, is added to prevent this activation.

Question 4

Explain the role of the natriuretic system in heart failure

Answer 4

Natriuretic peptides act on:
1. Blood vessels - dilate
2. Kidneys - excrete more sodium and water
3. Hormone - reduce production of hormones that worsen the heart failure (eg. adrenaline, angiotensin, aldosterone)

In heart failure, the heart chambers are stressed causing them to produce and release extra NP as a way to protect the heart from further damage.

Question 5

List 2 adverse effects of sacubitril/valsartan

Answer 5

Hypotension
Hyperkalemia
** Renal failure

Question 6

What are the 3 vasodilator drugs used in treatment of heart failure?

Answer 6

Hydralazine
Nitroglycerin
Isosorbide dinitrate

Question 7

Name an aldosterone receptor antagonist

Answer 7

Spironolactone

Question 8

What is the non-selective beta blocker used in heart failure?

Answer 8

Carvedilol

Question 9

What is the MOA of ivabradine?

Answer 9

Slows the HR by inhibiting the channel responsible for cardiac pacemaker current

Reduces spontaneous firing by SA node

Question 10

List 2 adverse effects of ivabradine

Answer 10

Bradycardia
Atrial fibrillation
Vision problems