HEART FAILURE Flashcards
what are the heart failures that depress systolic function and ejection fraction to less than 40 percent
coronary artery disease , dilated cardiomyopathy , valvular disease , congenital heart disease
what are the types of heart failure with preserved ejection fraction ?
restrictive cardiomyopathy , hypertrophic , fibrosisi , endomyocardial malfunction = diastolic failure
what is the classification of heart failure according tot he sympotms presented ?
class 1 normal physical activity
class2
physical activity shows mild form of dyspnea , palpitations and tirdness
class3
marked limitation in physical activity
les than the normal activity causes dyspnea palpitations and tiredness
class 4
symptoms even at rest
unable to carry any physical activity because it increases the discomfort
whata re the drugs in their step wise order for the treatmnet of SYSTOLIC HEART FAILURE?
diuretics
ACEI or ARB
beta blockers
mineralcorticoid/aldesterone receptor antagonist
—— lvef 35 percent or less , sinus rhythm and hr of over 70 beats per min :
inhibitors of If current only given in class 2
------ still nyha class 2-4 and lvej 35 percent and below -----> qrs duration 120s -----> crtp (pacemaker) if qrs duration less of 120 = ICD (defibrillator)
—— still nyha f class 2-4——
cardiac glycosides only given in 2b class H-ISDN - hydrasalazine and isosorbide denigrate
end stage : lvad (left ventricular assisting device or transplantation)
omega-3 polyunsatruated fatty acids - 2b class
what are the diuretics ?
loop diuretics
furosemide and torasemide
thiazides
hydrochlorothiazide
indapamide
DIURETICS
mechanism of action
indication
side effects
drug drug interactions
vasodilaion of so decrease in preload (atrial filling)
decrease edema and symptoms of pulmonary and venous congestion
indicatons
isolated systolic hypertension
elderly (FIRST CHOICE)
congestive heart failure with edema and syspnea
acute heart failure - loop diuretics
renal failure - loop diuretics
reduced ejection fraction in combo with ACEI or ARB
side effects hypotension hypokalemia renal impairment increase the LDL levels and lowers HDL increase in blood sugar levels = hyperglycemia and inuslin resistance increase the uric acid = to cause gout
DDI
loop diuretic or thiazides (potassium loosing diuretic ) can be used in combo with ACEI OR ARB (not together) because it causes activation of the RAAS system in mild hF (hypotension triggering)
thiazide and loop diuretics can be used in combo
potassium loosing diuretic (loop/ thiazides ) in combo with acei and arb and MRA (retain potassium) = potassium replacement not needed
but hyperkalemia if potassium sparing diuretics(eplerenone and spironolactone) in addition with ACEI and MRA
ACEI
mechanism of action
ACTION
reduction of peripheral vascular resistance by vasodilating
reduction of venous tone
fibrinolysis
on the myocardium = inhibition of ventricular remodelling = cardioportective
lv hypertrophy decreases
inhibition of vascular remodelling in retina and kidney
on the kidneys = decrease afferent arteriolar spasm
supress sodium reabsorption
neurohumoral action
suppression of sympathetic activity
increase bradykinin
side effects
contraindications
side effects
coughing
symptomatic hypotension such as dizziness
sometimes small rise in urea and creatinin but really not important = only if rapid and substantial
hyperkalemia
contra angioedema bilateral renal stenosis serum potasium over 5mmol/l serum creatinin over 22mmol/l sever aortic stenosis
beta blockers - which ones?
mechanims of action
side effects
contraindications
bisoprolol
carvedilol
metoprolol
nebivolol
stops sympathetic activity and remove catechlomines effect on myocardium aswell
WITH AN ACEI always (and then can add MRA)
side effects
hypotension
worsening of heart failure
bradycardia
contra bronchial asthma copd (in these cases selective b1 blockers used) second or third degree heart block sick sinus syndrome sinus bradycardia less than 50bpm
ARB
WHY DOES IT NOT CAUSE COUGH like ACEI
side effects
contra indications
has no effects on the metabolism of kinins unlike ACEI
side effect
same as ACEI but not cough
contra
same as ACEI but can be used in ANGIOEDEMA
oatients treated with ACEI AND MRA
adequate renal function and normal serum potassium conc
what are the ARB’s?
sartans
mechanism of action in minrealcorticoid / aldesterone receptor antagonists?
indications
side effects
reduces : endothelila dysfunction ventricular remodelling fibrosis in myocardium fibrinolysis
indications
LVEF is less than or equal to 35 perccent despite treatemnt with ACEI / ARB + and beta blocker
side effects
hyperkalemia = dose decrease if potassium more than 5.5mmol/l
serum creatinin rise - decrease dose if more than 220umol/l
breast tenderness or enhancemnet = spironolactone (go to eplerenone)
mineralcorticoid / aldesterone receptor antagonist
contra
drug drug intercations
contra
if if potassasium more than 6 mmol/l
if creatinin more than 310umol/L
what are the drug to drug interaction with mineralcorticoid/ aldesterone receptor antagonist ?
medications that rise potassium
NSAIDS - reduce renin = reduce aldosterone = potasium increase
trimethoprim-sulfamethoxazole = blocks amiloride sensitive sodium channels in the distal nephron
contraindicated =
eplerenone and cyp3A4 inhibitors such ketoconazole, clarithromycin , ritonavir
what is a cardiac glycoside ?
digoxin
