Heart Failure Drugs

Question 1

Symptoms of HF?

Answer 1

SOB
Ankle swelling
Lack of energy
Difficulty sleeping at night due to breathing problems
Swollen abdomen / loss of appetite
Cough with frothy sputum
Increased urination at night
confusion and or impaired memory

Question 2

52 yr old woman, MI 10 yrs ago - uncomplicated recovery but stopped taking all drugs since and has not seen doctor since discharge.
PC/ SOB on exertion. Mild ankle oedema. Nocturia.

Risk factors: smoker, FH of CVD, poor general lifestyle (overweight, no exercise, too much alcohol)

What investigation for diagnosis?

Answer 2

ECHO

which shows LV systolic dysfunction probably 2ndry to IHD and alcohol

Question 3

52 yr old woman, acute SOB

MI 10 yrs ago - uncomplicated recovery but stopped taking all drugs since and has not seen doctor since discharge.
.
Mild ankle oedema. Nocturia.

Risk factors: smoker, FH of CVD, poor general lifestyle (overweight, no exercise, too much alcohol)

What NYHA grade?

Answer 3

GRADE II

Class I - no limit on physical exercise
class II - slight limit on physical activity
class III - marked limitation - symptoms on less that ordinary activity
class IV - inability to carry out any physical activity without discomfort

Question 4

52 yr old woman, acute SOB

MI 10 yrs ago - uncomplicated recovery but stopped taking all drugs since and has not seen doctor since discharge.

Mild ankle oedema. Nocturia.

Risk factors: smoker, FH of CVD, poor general lifestyle (overweight, no exercise, too much alcohol)

What treatment ?

Answer 4

Lifestyle - exercise, alcohol, smoking (no lifestyle intervention has been shown to reduce mortality but evidence base is small)

Drugs reducing mortality (and improve symptoms):
ACEIs / ARBs
Beta blockers
Spironolactone - aldosterone antagonist
Nitrates (vasodilators - reduce pre-load and after load) - only helpful in Afro-Caribbeans not white patients

Drugs improving symptoms but no effect on mortality
Diuretics - furosemide (loop), thiazides (bendroflumethiazide), K sparing (amiloride)
Digoxin

For NYHA I - treat HTN, treat lipid disorders, lifestyle advice, ACE I
For NYHA II - ACEI, beta blocker , + above
FOr NYHA III - diuretics, ACE I, beta blockers, digitalis, dietary salt restriction
for NYHA IV - all above measures + mechanical assist devices

Question 5

SEs of diuretics:

Answer 5

Hypokalaemia
Hyponatraemia
Volume depletion
Renal impairment
Gout

Question 6

ACE I - MOA/ effect?

Answer 6

Block angiotensin converting enzyme so decreased angiotensin II
Angiotensin II is normally involved in vasoconstriction, renal salt and water retention and aldosterone secretion

Question 7

SEs of ACEI:

Answer 7

Renal impairment - rise in U&Es (If >50% needs review). Watch serum K.

Cough

Hypotension (after first dose)

Question 8

ARBs

Answer 8

Losartan, candesartan

- sartan

Question 9

52 yr old woman,
Comes to A&E - now NYHA III
DH - ACEI
Decompensated HF

What drugs could you add?
What are its SEs

Answer 9

Beta blockers

SEs - bradycardia, bronchconstriction, hypotension

Spironolactone - for NYHA III -IV
SEs: hyperkalaemia, gynaecomastia

Question 10

Therapy of HF includes 4 drugs.. what are they

Answer 10

Diuretics
ACEI
Beta blockers
Spironolactone