Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Therapeutics > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What re secondary and principle causes of heart failure?

A

Hypertension: hypertrophy increasing cardiac work
Ischaemic heart disease: impaired muscle function
Cardiomyopathies (alcohol, viral)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What might heart failure be precipitated by?

A 
Pregnancy
Anaemia
Hyper + hypothyroidism 
Fluid retaining drugs:
glucocorticoids 
NSAIDs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What neurohormonal adaption occurs in heart failure?

A

Sympathetic nervous system
RAAS (renin-angiotensin-aldosterone system)
ADH (anti diuretic hormone)
ANP (atrial natriuretic peptide) to promote sodium loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does neurohormonal adaptation lead to?

A

Increased afterload
Increased circulating volume (increased preload+afterload)
Increased resistance will lead to impaired renal function, more salt/water retention with further activation of RAAS
Myocyte dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What’s left-sided failure?

A

Often secondary hypertension

Left ventricle impaired (poor output) leads to increase in left atrial/pulmonary venous pressure with pulmonary oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is right-sided failure often due to?

A 
Lung disease (cor pulmonate)
Pulmonary valvular stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What’s biventricular failure?

A

Both chambers affected
Disease (IHD) has affected both ventricles
Left ventricular failure, leads to pulmonary congestion, may lead to right ventricular failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the signs and symptoms of heart failure?

A 
Fatigue, listless
Poor exercise tolerance (determines grade)
Cold peripheries
Low blood pressure 
Reduced urine flow
Weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the symptoms of left ventricular failure?

A 
Pulmonary oedema 
Dyspnoea 
Cough?
Orthopnoea (nocturnal?)
Inspiratory crepitations on auscultation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the symptoms of right ventricular failure?

A

Raised venous pressure
Increased JVP
Enlarged liver
Oedema- ankles, if lying down rises to thighs/abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is heart failure diagnosed?

A

Confirmed by echo- ejection fraction <45%
BNP levels (chronic heart failure)
CXR- cardiomegaly, pulmonary oedema, Kerley’s lines (due to sympathetic distension)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is atrial fibrillation?

A

LV/valve failure leading to increased pressure in left atrium, leading to distension which leads to AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can AF cause?

A

Stasis of blood and stagnation leading to thrombi which may dislodge and move to cerebral circulation (risk of transient ischaemic attack TIA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What do you need prophylaxis against in AF?

A

Thromboembolism

Warfarin or aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are goals of treatment for heart failure?

A

Identify/treat any cause (valvular disease/IHD)
Reduce cardiac workload
Increase cardiac output
Counteract maladaption
Relieve symptoms
Prolong quality life- reduce hospitalisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which patients should receive an ACEI?

A

All patients with left ventricular systolic dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is used first line in moderate/stable heart failure?

A

Beta-blockers

18
Q

What do ACEIs do?

A

Reduce arterial and venous vasoconstriction
Reduce after and pre-load
Reduce salt/water retention
Inhibit RAAS and so oppose neurohormonal adaptation and may prevent cardiac remodelling

19
Q

What should you do when treating with ACEI?

A

Low dose then titrate upwards- may exceed licensed max dose
Do not use with NSAIDs
Monitor urea/creatine and K+ before and during treatment
Avoid in hypotension- systolic <100mmHg

20
Q

What side effects do ACEIs cause?

A

Severe hypotension- withdraw diuretic therapy for a few days before; give at night
May cause deterioration of renal function in pre-existing renal disease

21
Q

When are diuretics used?

A

Mainstay of therapy
Thiazides- used in mild failure or in the elderly
Loop diuretics (furosemide) especially in pulmonary oedema (iv given for rapid relief)

22
Q

What do diuretics cause?

A

Cause reduction in circulating volume, reduce preload and afterload
Also cause venodilatation, reduce preload

23
Q

What can thiazides/loop diuretics cause?

A

Hypokalaemia

Less of a problem if they are used with ACEIs

24
Q

What are the common b-blockers used in heart failure?

A

Metoprolol
Bisoprolol
Carvedilol (also an a-blocker/antioxidant)
Nebivolol

25
Q

What do b-blockers do?

A

Reduce sympathetic stimulation, heart rate and oxygen consumption
Antiarrhythmic activity reduces sudden death
Oppose the neurohormonal activation which leads to myocyte dysfunction
Especially useful un failure associated with ischaemia

26
Q

What do you need to be careful of when treating with b-blockers?

A

Start with a low dose under supervision and then work up
Symptoms may get worse at 1st
May be appropriate in concurrent COPD if used with caution

27
Q

What is spironolactone?

A

Aldosterone receptor antagonist
Used as an effective agent which reverses the left ventricular hypertrophy
Low dose 25mg reduces mortality 35%
Inhibits effects of aldosterone on the heart- fibrosis which stiffens the heart

28
Q

What is digoxin?

A

Positive inotrope by inhibiting Na/K ATPase
Na accumulates in myocytes, exchanged with Ca leading to increased contractility
Impairs atrioventricular conduction and increases vagal activity (via CNS)
The heart block and bradycardia is beneficial in heart failure with AF

29
Q

What is digoxin contra-indicted in?

A

Concurrent heart block

Bradycardia

30
Q

What is digoxin reserved for?

A

Heart failure with AF

When other treatments fail to control the treatment

31
Q

How should you give digoxin?

A

Titrate dose to ensure ventricular rate does not fall below 60 beats/min as this indicates toxicity

32
Q

How is digoxin affected in renal impairment?

A

Dose of digoxin is reduced as it’s 2/3rds renal excreted

33
Q

What should you do with ACEIs and renal function?

A

Used in care in mild-moderate failure and renal function is monitored
Contraindicated in renovascular disease (renal artery stenosis, when blood pressure and renal perfusion are maintained by high levels of renin)

34
Q

Why should you monitor potassium?

A

Hypokalaemia
Side effect of thiazides/loop diuretics
Enhances the effects of digoxin
Possibility of hyperkalaemia with ACEI if used with a K+ sparing diuretic

35
Q

What are the problems caused by digoxin toxicity?

A

Narrow therapeutic window
Anorexia, nausea (dose too high), visual disturbances, diarrhoea
Digoxin in AF, monitor pulse (>60bpm)

36
Q

How should you treat LV dysfunction?

A

ACEI/b-blocker
Use ATRA if cough
Aldosgterone antagonist or ATRA or hydralazine plus nitrate if persistent symptoms
Then use digoxin

37
Q

Which drug should be avoided in heart failure?

A

Rate-limiting calcium channel inhibitors
Decrease cardiac activity and worsen heart failure
DHPs are considered safe

38
Q

What is used first line when there’s a reduced ejection fraction?

A

ACEI

39
Q

When is it best to take furosemide?

A

In the morning so that diuresis occurs during the day

40
Q

Why is verapamil contra-indicated in CHF?

A

Negative inotropic effects can worsen CHF

Therapeutics (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions