Heart failure treatment Flashcards
What are the aims of HF treatment?
-improve life expectancy
-improves quality of life
-minimise the need for hospital admissions
What are some lifestyle modifications for patients with HF?
-weight reduction
-discontinue smoking
-avoid alcohol and other cardiotoxic substances
-exercise
What medical considerations do we need to have for a patient with HF?
-Treat HTN, hyperlipidemia, diabetes, arrythmias
-coronary revascularization
-anticoagulation
-sodium restriction
-daily weights
-outpatient monitoring
Describe the use of diuretics/ furosemide ( loop diuretic) for pharmacological management of patients with HF
-used to relieve fluid retention
-improve exercise tolerance
-facilitate the use of other drugs indicated for HF
-patients can be taught to adjust their diuretic dose based on changes to their body weight
-electrolyte depletion a frequent complication
-should never be used alone to treat HF
-higher dose of diuretics are associated with increased mortality
How can ACE inhibitors such as ramipril/ lisinopril be used to treat HF?
-Blocks the conversion of angiotensin I to angiotenin II which prevents functional deterioration
Reduces BP by preventing vasoconstriction
-recommended for all HF patients
-relievs symptoms and improves excersise tolerance
-reduces risk of death and decrease disease progression
-benefits may not be apparent for 1-2 months after initiation
How are ARBs such as valsartan, candersartan, losartan used to treat HF?
-block AT1 receptors which bind circulating angiotensin II
-should not be considered equivalent or superior to ACE inhibitors
-In clinical practice, ARBs should be used to treat patients who are ACE intolerant due to intractable cough or who develop angiodema
How are aldosterone receptor antagonists such as spironolactone used to treat HF?
-generally well tolerated
-shown to reduce HF related morbidity and mortality
-generally reserved for patients with NYHA class III-IV HF
-side effects include hyperkalemia and gynecomastia. potassium and creatinine levels should be closely monitored
How are digoxins such as laxoxin used to treat HF?
Enhances inotropy of cardiac muscle
Reduces activation of SNS and RAAS
Controlled trials have shown long-term digoxin therapy:Reduces symptoms
-Increases exercise tolerance
-Improves haemodynamics
-Decreases risk of HF progression
-Reduces hospitalization rates for decompensated HF
-Does not improve survival
How are beta blockers such as bisoprolol and carvedilol used to treat HF ?
Cardioprotective effects due to blockade of excessive SNS stimulation
In the short-term, beta blocker decreases myocardial contractility; increase in EF after 1-3 months of use
Long-term, placebo-controlled trials have shown symptomatic improvement in patients treated with certain beta-blockers1
When combined with conventional HF therapy, beta-blockers reduce the combined risk of morbidity and mortality, or disease progression
What is CRT?
cardiac resynchronization therapy
CRT device:
-moderate to severe HF ( NYHA class III/IV ) patients
-symptomatic despite optimat, medical therapy
-ECG- QRS >/ 130 msec
-LVEF</35%
CRT plus ICD+ CRT-D
-same as above with ICD indications
Describe the treatment stratergies for the stage A HF
-treat hypertension
-treat lipid disorder,
-encourage regular excersise,
-discourgae alcohol intake, ACE inhibitors
(Stage A- at high risk no struc disease)
Describe the treatment stratergies for the stage B HF
-all measures under stage A
-ACE inhibitors in appropriate patients
-Beta blockers in appropriate patients
( Stage B- struc heart disease, assymptomatic)
Describe the treatment stratergies for the stage C HF
-all measures under stage A
-drugs,
diuretics, ACE inhibitors, beta blockers, digitalis, dietary salt restriction
(Stage C- struc heart disease with prior/current symptoms of HF )
Describe the treatment stratergies for the stage D HF
-all measures under stage A,B,C
-mechanical assist devices (LVAD)
-heart transplant
-continuous ( not intermittent) IV inotropic infusions for palliation
-hospice care
(Stage D- refractory HF requiring specialized interventions)
