Heart failure drugs

Question 1

Diuretics, ACE inhibitors, vasodilators - what do they do to help?

Answer 1

Reduce afterload on the heart (ie the resistance to blood being pushed out)
Donkey analogy: reducing the number of sacks on the wagon

Question 2

ACE inhibitors - examples and side effects

Answer 2

Lisinopril, enalapril, perindopril, ramipril

Renal failure, cough

Question 3

Angiotensin II antagonist - examples and side effects

Answer 3

Losartan, valsartan, candesartan, irbesartan

Renal failure

Question 4

Diuretics - examples and side effects

Answer 4

Loop diuretics:
• Frusemide, bumetanide
• Dehydration, rashes
Thiazide diuretics:
• Bendrofluazide, indapamide, metalozone
• Renal impairment
Should not be on a loop diuretic and a thiazide diuretic
Aldosterone antagonists:
• Spironolactone, eplerenone
• Dehydration, hyperkalaemia, renal failure, gnaecomastia

Question 5

Vasodilators

Answer 5

Often used in acute heart failure alongside diuretics

Beneficial especially in patients who can’t have ACE inhibitors due to renal failure

Question 6

Beta blockers - what do they do to help?

Answer 6

Block adrenaline receptors to control heart rate and reduce workload and O2 requirement
Donkey analogy: limit donkey’s speed thus saving energy
Prolong life

Question 7

Beta blockers - examples and side effects

Answer 7

Carvedilol, bisoprolol, metoprolol

Fatigue, exacerbation of asthma, cold peripheries, impotence

Question 8

Ivabradine

Answer 8

Slows heart rate via inhibition of funny channel

Question 9

Positive inotropes - what do they do to help

Answer 9

Make the heart work harder

Donkey analogy: carrot in front of the donkey

Question 10

Positive inotropes - examples and side effects

Answer 10

Digoxin only one used

Some GI effects, some drowsiness, dizziness

Question 11

Resynchronisation therapy

Answer 11

New idea
Increase efficiency
Criteria: LBBB, NYHA III or IV, EF <35%, uptitrated medications
Basically, intraventricular activation of contraction to allow ventricals to contract together in an organised way → improved active filling

Question 12

Left ventricular assist device

Answer 12

New idea
Bridge gap to transplantation
Complications: infection, device failure, bleeding, thromboembolism, RV failure
Pump connected to heart and aorta via an inflow and outflow cannula, a driveline that exits the skin on the right and a system controller that is typically worn on a belt.
Note: continuous flow - no pulse or blood pressure