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Year 1-Cardiovascular System > Heart Failure Treatment > Flashcards

Heart Failure Treatment Flashcards

1
Q

Describe LV systolic dysfunction.

A

Decreased pumping function of the heart, which results in fluid back up in the lungs and heart failure

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2
Q

Describe LV diastolic heart failure

A

Involves a thickened and stiff heart muscle
As a result, the heart does not fill with blood properly
This results in fluid backup in the lungs and heart failure

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3
Q

What can hypertension can lead to diastolic function which can then lead to…?

A

Systolic dysfunction

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4
Q

What can MI lead directly to concerning to LV?

A

Damage to the left ventricle and systolic dysfunction

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5
Q

What does heart failure usually occur as a result of? (2)

A

Prolonged hypertension
MI

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6
Q

What type of issues can prolonged hypertension lead to regarding HF?

A

Diastolic Dysfunction /Preserved ejection fraction HF
Progresses to reduced ejection failure systolic dysfunction

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7
Q

What issue can a MI lead to regarding HF?

A

Systolic Dysfunction

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8
Q

What can happen as a result to damage of the ventricle?

A

Cardiac output falls
Body registers this as a loss in circulatory volume so activates the sympathetic system and the renin-angiotensin-aldesterone system.

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9
Q

Which two systems become activated upon damage to the ventricle?

A

Sympathetic system
RAAS system (renin-angiotensin-aldesterone system).

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10
Q

What does activation of the sympathetic system lead to?

A

Vasoconstriction

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11
Q

What does activation of the RAAS lead to?

A

Salt and water retention

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12
Q

What happens as a result to sympathetic vasoconstriction?

A

Increased afterload

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13
Q

What happens as a result to RAAS salt and water retention?

A

Increased circulatory volume

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14
Q

What can increased circulatory volume lead to in terms of the heart?

A

As circulatory volume increases the heart dilates, the force of contraction weakens and cardiac output drops further

This leads to further activation of the sympathetic and RAAS systems hence starting a vicious cycle

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15
Q

What are the aims of HF treatment?

A

Improve symptoms
Improve quality of life
Prevent hospital admission
Reduce mortality rates

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16
Q

Which drug can be given o those w HF to reduce symptoms for those with water and salt retention?

A

Furosemide, a type of loop diuretic

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17
Q

What drugs are used if a patient develops resistance to loop diuretics?

A

Use loop in combination with thiazide diuretics

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18
Q

There are several adverse drug reactions to diuretics.
What are some of the adverse reactions to loop diuretics if used in excess?

A

Dehydration
Hypotension
Hypokalaemia, Hyponatraemia
Gout
Impaired glucose tolerance, diabetes

19
Q

List some groups of drugs which are Neuro-hormonal Antagonists.

A

ACE Inhibitors
Beta receptor blockers
Mineralocorticoid Receptor Blockers
Combined angiotensin blockade plus ANP/BNP enhancement

20
Q

RECAP- which system do ACE inhibitors block?

A

RAAS

21
Q

RECAP- give some examples of CAE inhibitors.

A

Ramipril
Enalapril
Lisinopril

22
Q

What affect do ACE inhibitors have?

A

Block angiotensin converting enzyme which prevents conversion of angiotensin 1 to angiotensin 2.
Reduces preload and afterload.

23
Q

What are some of the adverse drug reactions to ACE inhibitors?

A

Cough
Angioedema
Renal impairment
Renal failure
Hyperkalaemia

24
Q

Which drugs can ACE inhibitors interact with?

A

NSAIDS - leading to acute renal failure
Potassium supplements - leading to hyperkalaemia
Potassium sparing diuretics - leading to hyperkalaemia

25
Q

What do ARB’s (angiotensin receptor blockers) do?

A

Guess what? They selectively block angiotensin II receptor

26
Q

What is Valsartan-Sacubitril (ARNI)?

A

Combined valsartan and ARB and Neprilysin Inhibitor

27
Q

What does Valsartan-Sacubitril (ARNI) do?

A

ARB blocks AT1 (angiotensin 1) receptor
Neprilysin inhibitor stops break down of ANP and BNP by neutral endopeptidases

28
Q

Who is recommended to be treated with Valsartan-Sacubitril (ARNI)?

A

Option for treating symptomatic chronic heart failure with reduced ejection fraction, in people:
-with New York Heart Association (NYHA) class II to IV symptoms
-with a left ventricular ejection fraction of 35% or less and
-who are already taking a stabledose of angiotensin‑converting enzyme (ACE) inhibitors or angiotensin II receptor‑blockers (ARBs).

very wordy but read through and try to understand

29
Q

What do Mineralocorticoid receptor antagonists do?

A

Block receptors that bind aldosterone and other steroid hormone receptors

30
Q

Give two examples of mineralocorticoid receptor antagonists.

A

Spironolactone and eplerenone

31
Q

Who is recommended to be treated with spironolactone or eplerenone (both mineralocorticoid receptor antagonists)?

A

Recommended for all symptomatic patients with HFrEF (heart failure with reduced ejection fraction) and LVEF ≤35%

32
Q

What do beta blockers do?

A

Block the responses of the sympathetic system, reducing the activity of the heart.

33
Q

Name two beta blockers

A

Bisoprolol
Carvedilol

34
Q

You need to be careful when using beta blockers- why?

A

Only to be used to stabilised patients.
Do not use during acute presentation

35
Q

How does the drug ivabradine lower HR?

A

Inhibition of If channel in the sinus node

36
Q

In which patients should ivabradine be used?

A

Only used in patients with sinus rhythm

37
Q

Which positive inotrope drug may be used in the treatment of HF?

A

Digoxin

38
Q

What does digoxin do?

A

Increases availability of calcium in the myocyte

39
Q

What are some of the disadvantaged of digoxin?

A

No effect on mortality
Narrow therapeutic index

Side effects-
Arrhythmias
Nausea
Confusion

40
Q

What can a narrow theraputic index mean?

A

Increased risks of toxicity

41
Q

If a patient had HF and congestion, which drugs would you give?

A

A diuretic like Furosemide ± thiazide

42
Q

If a patient is intolerant of an ACE inhibitor, what may be given?

A

Angiotensin receptor blocker

43
Q

If a patient is intolerant or still symptomatic upon treatment of ACE inhibitors/angiotensin receptor blocker, what might be given?

A

ARNI

44
Q

How is the benefit of treatment monitored?

A

Symptom relief
Patient education
Clinical relief
Regular weight monitoring

Year 1-Cardiovascular System (41 decks)

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