Heart Failure Treatment Flashcards
What are the two types of HF?
HFrEF - decreased pumping function of the heart, resulting in fluid back into the lungs.
HFpEF - thickened and stiff heart muscle cannot fill properly with blood, resulting in fluid back into the lungs.
What are the risk factors for HF?
Hypertension, MI, age, F>M.
What is the relationship between the Frank-Starling Law and HF?
A failing/damaged heart cannot contract with force and pump blood.
Circulatory volume increases, the heart dilates, contraction strength weakens, and CO falls.
SNS and RAAS are activated.
What are the results of the neurohormonal disturbances of HF?
Vasoconstriction - myocyte death, fibrosis.
Salt and water retention - peripheral and pulmonary oedema.
What are the benefits of HF treatment?
Improves clinical status, functional capacity, and QoL.
Reduces hospital admissions and mortality.
Relief from symptoms.
What is furosemide?
A first line HF loop diuretic.
Patients can become resistance.
Very potent with thiazide diuretics.
What are the ADRs and DDIs of furosemide?
ADRs - dehydration, hypotension, hypokalaemia, hyponatraemia, gout, diabetes.
DDIs - renal toxicity with NSAIDs, vancomycin and aminoglycosides; hypotension with antihypertensives.
What are ACEis?
Reduces preload and afterload.
Reduces morbidity and mortality.
What are the ADRs and DDIs of ACEis?
ADRs - cough, angioedema, renal impairment/failure, hyperkalaemia.
DDIs - hyperkalaemia with potassium supplements and sparing diuretics; acute renal failure with NSAIDs.
What are ARBs?
Not consistently proven to reduce mortality in HFrEF; used in ACEi-intolerant patients.
What is ARNI?
For symptomatic chronic HF, with reduced EF, in people with - NYHA class II+, LVEF < 35%, or taking stable doses of ACEis/ARBs.
What are spironolactone and eplerenone?
Mineralocorticoid receptor antagonists.
Recommended in all symptomatic patients with HFrEF and LVEF < 35%, to reduce mortality and hospitalisations.
Reduces mortality when with ACEis.
What are carvedilol and bisoprolol?
BBs - reduces morbidity and mortality.
Only used when a patient has been stabilised and not during an acute presentation, since fluid overload with cause severe deterioration.
What is ivabradine?
Only for patients with sinus rhythm.
Reduces hospitalisation in stable chronic HFrEF with standard therapy and HR > 70.
What is digoxin?
A positive inotrope.
Reduces hospitalisations.
Has a narrow TI.
ADRs - arrhythmia, nausea, confusion.
