Heart Failure as a Drug Target

Question 1

What is heart failure?

Answer 1

An inability of the heart to pump blood effectively around the body - Can’t meet the body’s need.

Question 2

What are the symptoms of heart failure?

Answer 2

Shortness of breath.
Fatigue.
Swelling.

Question 3

What is left sided heart failure?

Answer 3

The left ventricle DOES NOT pump efficiently and therefore, prevents body from getting enough O2 rich blood.
This causes a fluid build up in the lungs.

Question 4

What are the symptoms of left sided heart failure?

Answer 4

Breathlessness.

Pink sputum whilst coughing.

Question 5

What is right sided heart failure?

Answer 5

There is NOT enough pumping of blood to the lungs as normal.
This causes a fluid build up in the legs.

Question 6

What are the symptoms of right sided heart failure?

Answer 6

Heavy painful legs.
Difficulty walking.
Skin infections.
Pitting Oedema.

Question 7

What is a ‘Pitting Oedema’?

Answer 7

When you place a thumb on your leg -> there would be a depression where the thumb was.
This is due to the oedema build up in the legs.

Question 8

What is congestive cardiac failure?

Answer 8

This is a failure of both sides of the heart due to fluid build up AROUND the heart -> Affects pumping power of the heart.

Question 9

What are the places where fluid build up is common in heart failure patients?

Answer 9

Lungs
Abdomen
Liver

Question 10

How many stages are there in congestive cardiac failure?

Answer 10

4 stages.

Question 11

What are the 2 main ways of measuring heart failure?

Answer 11

BNP

Echocardiogram

Question 12

What is BNP?

Answer 12

Brain Natriuretic Peptide.

Question 13

How is a BNP test done?

Answer 13

Blood is drawn up from the veins (Known as a venipuncture).

Question 14

What is the ‘abnormal level’ for a BNP test?

Answer 14

Greater than 100pg // ml is abnormal.

Question 15

What is an indicator of a high BNP score?

Answer 15

Heart failure is of a great risk.

Question 16

How is more BNP released?

Answer 16

More stretch in the heart vessels results in more BNP being released and this depicts that the heart is being put under immense pressure.

Question 17

How can an ECG show heart failure?

Answer 17

There is a DILATED left ventricle (alongside mitral regurgitation) and thus, there is increased pressure which can lead to heart failure.

Question 18

What is mitral regurgitation?

Answer 18

This is the leakage of blood back through the mitral valve each time the left ventricle contracts.

Question 19

What is cardiomyopathy?

Answer 19

This is when the muscle is TOO THIN and therefore, can’t contract due to weak forces and pressure.

Question 20

What is cardiac hypertrophy?

Answer 20

Muscle is TOO THICK because it can’t contract and thus filling of the heart with blood doesn’t occur properly.

Question 21

What is the ejection fraction like with cardiomyopathy?

Answer 21

Reduced ejection fraction.

Question 22

What is the ejection fraction like with cardiac hypertrophy?

Answer 22

Preserved ejection fraction.

Question 23

What are the causes of heart failure?

Answer 23

Ischaemic heart disease
Hypertension 
Valve Disease
Cardiomyopathy
Atrial Fibrillation

Question 24

What is preload?

Answer 24

Initial stretching of cardiac myocytes prior to the contraction.

Question 25

What is preload like during heart failure?

Answer 25

This is elevated due to ventricular dilation and increased blood volume.

Question 26

How can preload be reduced?

Answer 26

Loop Diuretics = Furosemide

Aldosterone Antagonist = Spironolactone

Question 27

How can loop diuretics reduce preload?

Answer 27

Acts on the Na+ // K+ // 2Cl- symporter in the thick ascending limb of the loop of Henle.

Question 28

How can aldosterone antagonist reduce preload?

Answer 28

Decreases sodium reabsorption.

Question 29

What is afterload?

Answer 29

Pressure the heart must work against in order to eject blood during systole.

Question 30

How can you reduce afterload?

Answer 30

ACE inhibitors = Ramipril

Calcium Channel Blockers = Amlodipine

Question 31

What is rate control?

Answer 31

This is slowing the heart down = Improving the ejection fraction.

Question 32

How do you reduce the heart rate?

Answer 32

Beta Blockers // Calcium Channel Blockers.

Question 33

What is rhythm control?

Answer 33

Improving heart efficiency can improve the symptoms.

Question 34

How do you improve heart rhythm?

Answer 34

Beta Blockers are used.

Digoxin can be added on at the end.