HEART FAILURE Flashcards
What is heart failure?
- Progressive condition
- Causes reduced cardiac output
How are chronic heart failures defined?
- Preserved ejection fraction
- left ventricle loses its ability to RELAX normally
- therefore the ejection fraction is normal or only mildly reduced - Reduced ejection fraction
- left ventricle loses its ability to CONTRACT normally
- therefore presents with an ejection fraction of less than 40%
Heart failure symptoms
- SOB
- persistent coughing/ wheezing
- ankle swelling
- reduced exercise tolerance
- fatigue
Risk factors
- male
- age
- diabetic
- smokers
Chronic heart failure - non drug treatment
smoking cessation
reducing alcohol consumption
increasing PA
salt intake of less than 6g/day
1st line treatment
- ACEi + BB (bisop/ carvedilol)
- initiated at low dose and slowly titrated up to max tolerated dose
- Give ARB if ACEi not tolerated
- Give hydralazine + nitrate if both ACEi ad BB not tolerated - ACEi + BB + aldosterone antagonist (spironolactone)
ACEi for HF
e.g. perindopril, ramipril, captopril, enalapril maleate, lisinopril, quinapril or fosinopril sodium
BB for HF
bisoprolol
carvedilol
nebivolol
ARB for HF
candesartan
losartan
valsartan
If heart failure symptoms persist or worsen despite optimal first-line treatment
add an aldosterone antagonist
spironolactone/ eplerenone
When would you not add an aldosterone antagonist?
unless contraindicated (e.g. due to hyperkalaemia or renal impairment).
If pt is already on BB
Patients who are already taking a beta-blocker for co-morbidities (e.g. angina or hypertension) and whose condition is stable should be switched to a beta-blocker licensed for heart failure.
Hydralazine hydrochloride combined with a nitrate
- can be considered under the advice of a heart failure specialist in patients who are intolerant of both ACE inhibitors and ARBs
- in particular those of African or Caribbean origin with moderate to severe heart failure
If symptoms persist despite optimal treatment
add amiodarone, digoxin, sacubitril with valsartan, ivabradine, empagliflozin, or dapagliflozin.
digoxin for pt in sinus rhythm in worsening or severe HF
Diuretics are recommended
for the relief of breathlessness and oedema in patients with fluid retention.
Loop diuretics
furosemide, bumetanide, or torasemide
Patient experienced acute coronary syndromes are prescribe dual antiplatelet
aspirin + cloidogrel/ prasugrel/ ticagrelor.
an ACEi, BB and statin
What are the monitoring requirements for standard treatment in heart failure?
- Serum K+
- Serum Na+
- Renal function
- Blood pressure
- Measured before and 1-2 weeks after starting treatment (at a each dose increment)
- Once stabilised on treatment, monitor MONTHLY for 3 months, then every 6 months
How often should patients with heart failure weigh themselves?
- DAILY at same time
- Report any weight gain of
1.5-2kg (gained in 2 days) to
GP or specialist (sign of oedema)
What vaccinations should be offered to patients with heart failure?
Annual vaccination against:
- Influenza
- Pneumococcal disease
Which Diabetic drugs have recently been granted license for the treatment of chronic heart failure?
- Dapagliflozin
- More recently: Empagliflozin
- Both are SGLT2 inhibitors
- They have been shown to reduce mortality and hospitalizations in heart failure patients
When would SGL2 inhibitors be given in heart failure?
Add on therapy to standard treatment, e.g.:
1. ACE-I (or ARB) + BB + SGL2
inhibitor
Or
2. ACE-I (or ARB) + BB +
Aldosterone antagonist + SGL2
inhibitor
OR WITH SACUBITRIL/ VALSARTAN + BB combo
3. Sacubitril/valsartan + BB + SGL2 inhibitor
or
4. Sacubitril/valsartan + BB + Aldosterone antagonist + SGL2
inhibitor
