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X Pharmacological Treatment Of Disease > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is heart failure?

A

Failure to deliver adequate blood to the body
Failure as a pump

Insufficient oxygen and metabolic supply to the tissues

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2
Q

What are the causes of heart failure?

A
  1. Ischaemic damage (chronic)
  2. Excessive cardiac workload (hypertension or valve disease)

-> stiffening of valves - changes morphology of the heart

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3
Q

What is the equation for cardiac output?

A

Heart rate (bpm) x stroke volume (L/b)

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4
Q

What often causes the problems in heart failure?

A

Stroke volume - less ejected blood

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5
Q

What is cardiac index?

A

Cardiac index (L/min/m2) = cardiac output/body surface area

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6
Q

What is the pathophysiology of heart failure?

A

Pump failure
Fall in blood pressure
Reflex compensatory mechanisms
1. Retention of salt and water -> increased blood volume (renin-angiotensin-aldosterone system)
2. Reflex tachycardia and vasoconstriction (baroreceptor reflex)

= increase cardiac workload which exacerbates the heart failure

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7
Q

What happens when the right hand pump fails?

A
  1. Right hand fails
  2. Build up in venous side
  3. Vessels distend
  4. Oedema (hydrostatic pressure)
  5. Swollen ankles, enlargement of liver
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8
Q

What happens when left hand pump fails?

A
  1. Left hand fails
  2. Increased pulmonary pressure
  3. Pulmonary oedema
  4. Insufficient oxygen exchange
  5. Breathlessness
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9
Q

Why measure CVP?

A 
Establish the pressure in the right atrium
Establish blood volume deficits
Evaluate circulatory failure
Act as a guide in fluid replacement
Reflect response to treatment
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10
Q

How do you measure pulmonary pressure?

A

The Swanz-Ganz Catheter

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11
Q

What does the Swanz-Ganz catheter do?

A

Measure pulmonary artery and diastolic pressure or pulmonary wedge pressure

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12
Q

What does measuring pulmonary pressure reflect?

A

Left atrial pressure (left ventricular diastolic filling pressure)

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13
Q

Treatment of heart failure

What can be administered to decrease the workload?

A

ACE Inhibitors
Diuretics
Beta-Blockers

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14
Q

Treatment of heart failure

What can be administered to increase the force of contraction?

A

Cardiac glycosides

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15
Q

To treat heart failure, what 2 ways can you treat it?

A

Decrease workload

Increase force of contraction

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16
Q

A new heart failure diagnosis is made- how do you treat it at first?

A

ACE Inhibitor and titrate upwards

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17
Q

What happens if the first treatment doesn’t work?

A

If ACE inhibitor not tolerated, consider angiotensin II antagonist (ARB)

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18
Q

Why would the first treatment not be tolerated?

A

Severe cough for example

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19
Q

What would be the second treatment option?

A

Add beta-blockers and titrate upwards

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20
Q

What if patient was still moderately- severely symptomatic after the second treatment?

A

Administer spironolactone (diuretic)

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21
Q

Why would you administer diuretic to a patient with heart failure?

A

To control congestive symptoms and fluid retention

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22
Q

When would you give digoxin?

A

If patient still symptomatic with diuretic, ACE inhibitor and beta blocker

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23
Q

What do you do when the patient has all the available medication and is still symptomatic?

A

Seek specialist advice

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24
Q

What do ACE inhibitors do?

A

Inhibit the synthesis of angiotensin II by blocking angiotensin enzyme

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25
Q

What is angiotensin II?

A

Vasoconstrictor

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26
Q

When is angiotensin II released?

A

In renin-angiotensin-system

27
Q

What does angiotensin enzyme do?

A

Convert angiotensin I -> angiotensin II

28
Q

What is the result of inhibiting angiotensin II synthesis?

A

Decreased peripheral resistance and reduction in blood pressure

29
Q

What examples of ACE inhibitors are there? (name 3)

A

Enalapril, Lisinopril, Ramipril

30
Q

How does the renin-angiotensin system work?

A
  1. Kidney releases renin
  2. Renin acts on the pathway of angiotensinogen -
    > angiotensin I
  3. Angtiotensin I is converted to angiotensin II via angtiotensin converting enzyme
  4. Angtiotensin II is converted to aldosterone
  5. Aldosterone leads to sodium and water retention
  6. Angtiotensin II leads to vasoconstriction
  7. Vasoconstriction and sodium and water retention lead to the increase in BP
  8. Vasoconstriction also leads to increased afterload
  9. Increased afterload and blood pressure lead to heart failure
  10. Heart failure leads to low blood pressure
  11. low blood pressure acts on the kidney which acts on the kidney
31
Q

Why are there angiotensin receptors in the medulla?

A

To prevent aldosterone release

32
Q

What is lorsartan?

A

Angiotensin II receptor antagonist

33
Q

Why would you use lorsartan?

A

Alternative to ACE inhibitors that may give a dry persistent cough

34
Q

How do ACE inhibitors cause a cough?

A

Bradykinin is converted to inactive metabolites. ACE inhibitors block this conversion which leads to a build up of bradykinin. This build up causes a cough

35
Q

What are ARBs?

A

Angiotensin receptor blockers

36
Q

What do ARBs do?

A

Block Angtiotensin I -> Angiotensin II.

37
Q

Do ARBs cause a cough? Why?

A

No - specific to angiotensin I. ACEs aren’t which is why they act on Bradykinin

38
Q

What are direct renin inhibitors used for and why?

A

Angiotensin II can be produced by other pathways so block renin

Also, when Angiotensin II is blocked, renin builds up, so need to inhibit it

39
Q

What is an example of a direct renin inhibitor?

A

Aliskaren

40
Q

What are diuretics used for?

A

Reduce blood pressure and fluid overload

41
Q

What 3 kinds of diuretics are available?

A

Thiazaides
Loop diuretics
Potassium-sparing diuretics

42
Q

What is an drug example of a Thiazaide?

A

E.g. bendroflumethiazide

43
Q

What do thiaziaides do?

A

Decrease blood volume and inhibits sodium reabsorption in distal tubule

44
Q

How do thazaides decrease blood volume?

A

Inhibit sodium reabsorption in distal tubule

45
Q

What is an example of a loop diuretic?

A

Furosemide

46
Q

What do loop diuretics do?

A

Decrease blood volume

47
Q

How do loop diuretics decrease blood volume?

A

Inhibit sodium reabsorption from loop of Henle

48
Q

Whats more potent - Thiazaides or loop diuretics?

A

Loop diuretics

49
Q

What kind of heart failure do loop diuretics treat?

A

Severe heart failure

50
Q

What is a side effect of loop diuretics? How?

A

Encourages potassium excretion - can cause hypokalaemia

51
Q

What two kinds of potassium-sparing diuretics are there?

A

Aldosterone receptor antagonists

Sodium channel blockers

52
Q

What is an example of an aldosterone receptor antagonist?

A

Spironolactone

53
Q

What heart failure is spironolactone used to treat?

A

Severe heart failure

54
Q

What is an example of a sodium channel blocker?

A

amiloride

triametrene

55
Q

What do beta-blockers do?

A

Block sympathetic stimulation of the heart to reduce contractility

56
Q

What treatment are beta-blockers used alongside?

A

ACE inhibitors and diuretics

57
Q

3 examples of beta blockers

A

Carvedilol, bisoprolol, metoprolol

58
Q

Are cardiac glycosides an inotrophic drug or a chronotrophic drug?

A

Inotrophic

59
Q

What are cardiac glycosides used for?

A

Increase force of contraction

60
Q

What two types of digitalis are there?

A

Digoxin - White fox glove

Digitoxin - Purple foxglove

61
Q

What is the mechanism of action of cardiac glycosides?

A

Competitively bind to K+ site of Na+/K+ ATP-ase pump in myocytes- inhibiting it

Inhibition leads to Na+ build up on the inside of the cell

High Na+ concentration inside the cell leads to reduces Ca2+ and Na+ exchange:
Ca2+ is meant to be pumped out, Na+ pumped in - already Na+ build up so slows this

Increases intracellular Ca2+ levels

More Ca2+ available in cell for muscle contraction

62
Q

Na+/K+ ATP-ase pump - Which of Na+ and K+ is on the inside of the cell, and the outside?

A

K+ - Outside

Na+ - Inside

63
Q

give 2 examples of cardiac glycosides

A

digoxin

digitoxin

X Pharmacological Treatment Of Disease (9 decks)

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