Heart failure algorithm Flashcards
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The first-line treatment for all patients is ?
an ACE-inhibitor and a beta-blocker
one drug should be started at a time
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furosemide not prevent reduce the mortality but alleviate the symptoms
beta-blockers licensed to treat heart failure in the UK include
bisoprolol, carvedilol, and nebivolol
The standard second-line treatment
aldosterone antagonist
spironolactone and eplerenone
when starting second line treatment what are the cautions to be aware of ?
ACE inhibitors (which the patient is likely to already be on) and aldosterone antagonists both cause hyperkalemia
Third-line treatment should be initiated by a specialist. Options include?
(SGLT 2 inhibitors have increasing using gliflozosin - // SGLT-2 INHIBITORS - WITH A REDUCED EJECTION FRACTION // )
ivabradine,
sacubitril-valsartan,
hydralazine in combination with nitrate,
digoxin
cardiac resynchronisation therapy
when should ivabradine be considered in heart failure ?
sinus rhythm >75/min
LVEF <35%
NO RESPONSE ACEi , beta blocker and aldosterone antagonist therapy
criteria for sacubitril-valsartan
left ventricular fraction < 35%
//SYMPTOMATIC ON ACE INHIBITORS OR ARBS
SHOULD BE INITIATED FOLLOWING ACEI OR ARB WASH-OUT PERIOD//
criteria for hydralazine in combination with nitrate
// PARTICULARLY INDICATED IN AFRO-CARIBBEAN PATIENTS //
criteria for cardiac resynchronisation therapy
include a widened QRS (e.g. left bundle branch block) complex on ECG
// IMPROVED SYMPTOMS AND REDUCED HOSPITALISATION IN NYHA CLASS III PATIENTS //
Other treatments
offer annual influenza vaccine
offer one-off pneumococcal vaccine
one-off pneumococcal vaccine where adults usually require just one dose but who needs a booster every 5 years
asplenia, splenic dysfunction or chronic kidney disease
when is digoxin indicated ?
Not been proven to reduce mortality in patients with heart failure.
It may however improve symptoms due to its inotropic properties
it is strongly indicated if there is coexistent atrial fibrillation
Mechanism of action of neprilysin inhibitor, sacubitril, in combination with the angiotensin II receptor blocker, valsartan
Prevents degradation of ANP and BNP
Digoxin mechanism of action ?
inhibits Na+-K- ATPase pump in myocardial cells resulting in a transient increase of intracellular sodium, which in turn promotes calcium influx via the sodium-calcium exchange pump leading to increased contractility
digoxin should not be administered with ?
hypokalemia, it becomes easier for digoxin to bind to ATPase, leading to toxicity. Furosemide and other diuretics can lower potassium levels, resulting in digoxin toxicity
