Heart Failure Therapy Flashcards
Two types of Heart failure
systolic
diastolic
Systolic heart failure
decreased pumping function of the heart
fluid generates in the lungs and you get heart failure
Diastolic heart failure
thickened/stiff heart
therefore heart doesn’t fill with blood properly
(fluid generates in lungs and you get heart failure)
Risk factors for heart failure
coronary artery disease
hypertension
valvular heart disease
alcohol
infection
diabetes
congenital heart defects
Frank starling law
is the muscles of a healthy heat is stretched it will contract with greater force and pump out more blood
as circulatory volume increases, the heart dilates and the force of contraction
weakens, and cardiac output drops further
reduced cardiac output will activate what system?
RAAS system
Loss of blood (circulatory system) will lead to
vasoconstrictor system activation (sympathetic)
salt and water retention (RAAS)
The RAAS causes the release of
angiotensin II
aldosterone
The result of RAAS activation is
salt and water retention
vasoconstriction
hypertrophy
fibrosis of cardiac myocytes
Activation of the sympathetic system causes the release of
adrenaline
noradrenaline
noradrenaline and adrenaline release ill cause
vasoconstriction
stimulate renin release
myocyte hypertrophy
Progressive retention of salt and water results in
oedema
pulmonary oedema
Treatment to improve symptoms
diuretics
digoxin
treatment to improve symptoms AND survival
ACE inhibitor
spironolactone
Treatment to improve survival
beta blockers
ivabradine
Heart failure symptomatic treatment mat also involve treating
loop diuretics
sympathetic activation
(biosprolol)
two groups of drugs to block the effects of angiotensin II
ACE inhibitors (ramipril)
Angiotensin antagonists (Valsartan, Losartan)
Aldosterones effects can be blocked by
spironolactone
ANP and BNP are potent
vasodilators
Enhancing cardiac function can be done by treating with
positive inotropes
vasodilators
Positive inotropes
improve the ability of the heart to pump and improve cardiac status
passive inotrope drug commonly used
Digoxin
Loop diuretics function
removes excess water and salt
inhibit the Na-K-Cl transporter in the loop of henle
Diuretic patients can use in combination with thiazide diuretics - however this can induce diuresis of
5-10 litres per day
What drug groups would be used to reduce mortality?
angiotensin blocker
beta receptor blocker
aldosterone blocker
ANP/BNP enhancer
ACE inhibitor drugs
Ramipril
Enalapril
Lisinopril
ACE inhibitors function
competitively block angiotensin II converting enzymes
reduced preload AND after load on heart
Angiotensin II receptors blockers are only used when
ACE inhibitors can’t be
ACEI are more effective
Aldosterone antagonist
spironolactone
diuretic
(used in combination with loop diuretics)
Beta blockers examples
carvedilol
bisoprolol
metoprolol
Beta blockers should only be used on patients with chronic heart failure when they have
stabilised
Ivabradine
specific inhibitor of the If current in the sinoatrial node
Positive inotrope example
digoxin
Digoxin
increase availability of calcium in the myocyte
reduced number of hospital stays
anticoagulant example
warfarin
warfarin
prevents thrombus formation and thrombosis-embolic events
always monitor their weight daily for…
how much fluid they may be loosing etc
