Heart failure and its management Flashcards
What are the affects of heart failure
Afterload goes up, contractility and heart rate goes up, high pressure in venous system, leakage of fluid from capillaries
Which vessels will leak in left/right sided heart failure
Left- veins coming from lungs
Right- veins coming from rest of the body
What are mechanisms such as vasoconstriction and fluid retention designed to do
Restore blood pressure
What other systems are activated to restore blood pressure
- Anti-diuretic hormone
- Natriuretic peptides
- Atrial stretch
What is congestive heart failure
when the heart muscle is overworked due to stress, high blood pressure, arteriosclerosis, and fluids begin to collect in the body tissues, esp the lungs
What is meant by chronic backward failure
Not all the blood is pumped out of the ventricle, can result in fluid retention and high venous pressures
What do we characteristically see in left sided heart failure
Congestion of the pulmonary venous circulation, resulting in oedema formation in the interstitial fluid of the lungs and ultimately the alveoli of the lungs
What do we characteristically see in right sided heart failure
Congestion of the systemic venous circulation. Fluid leaks into body cavities, have a very distended jugular vein
What are typical presentation from a patient with left sided heart failure
- Coughing, fluid on lungs
- collapse
- heart disease in some cases
- non specific weight loss
Describe stage A of heart failure
Patients at high risk of developing heart failure. No identifiable structural disorder of the heart
Describe stage B1 and B2 heart failure patients
B1= asymptomatic patients, patients with no radiographic/ echocardiographic evidence of cardiac remodelling B2= Asymptomatic patients with radiographic or echocardiographic evidence of left sided heart failure
Describe stage C heart failure patients
Patients with past or current clinical signs of heart failure associated with structural heart disease
Describe stage D heart failure patients
patients with end-stage disease, clinical signs of heart failure
What are the main outcomes from cardiomyopathy
- Cardiac muscle fails
- Stroke volume fails
- Cardiac output fails
Which group of drugs help the heart relax
Positive lusitropes (calcium channel blockers, beta blockers)
What things should an owner consider in stage B1 heart failure
- weight control
- regular re-assessment
- client education
What treatment should you consider for a patient in stage B2 heart failure
- Pimobendan
- weight control
- regular re-assessment
- client education
What is traditionally used to remove diuretics
- loop diruretics= furosemide, torasemide
- Aldosterone antagonists= spirononlactone
What can venodilators and arterial dilators do to help with vasodilation
Venodilators= increase venouse capacity, decrease preload, reduce fluid build up
Arterial dilators= reduce afterload, increase output, reduce valve leakage
What is the effect of ACE inhibitors in tackling heart failure
- reduce level of angiotensin II
- this causes vasodilation
- reduces pre-load
- reduces systemic congestion
How are dysrhythmias treated in a patient with heart failure
Require characterisation with ECG- antidysrhythmic drugs, beta blockers, calcium channel blocker, digoxin
What are some adverse affects to therapy in treating heart failure/ dysrhythmias
- dose too high= lean weight/ fluid presence
- complecating factors e.g. renal dysfunction
- co-existing disease e.g. liver dysfunction
- effect of combinations of drugs
- will never be cured, only treating symptoms
