Heart failure Treatment Flashcards
What are the aims of treatment?
-improve life expectancy
-improve quality of life
-minimise the need for hospital admissions
What are lifestyle modifications for HF?
-weight reduction
-stop smoking
-avoid alcohol etc
-exercise
What are medical considerations for HF?
-treat hypertension, hyperlipidemia, diabetes, arrhythmias
-coronary revascularisation
-anticoagulation
-sodium restriction
-daily weights
-outpatient monitoring
How are diuretics used to treat HF?
-relieve fluid retention
-improve exercise tolerance
-facilitate use of other drugs indicated for HF
-taught to adjust dose based on changes in body weight
-electrolyte depletion is a complication
-shouldnt be used alone to treat
-higher doses associated with increased mortality
How are ACE inhibitors used to treat HF?
-blocks conversion of angiotensin I to angiotensin II (prevents deterioration
-recommended for all patients
-relieves symptoms and improves exercise tolerance
-reduces risk of death and decreases disease progression
-benefits 1-2 months after intiation
(stops vasoconstriction)
How are Angiotensin receptor blockers (ARBs) used to treat HF?
-block AT1 receptors which bind to circulating angiotensin II
-shouldnt be considered equal to ACE inhibitors
-ARBs should be used to treat patients who are ACE intolerant
How are aldosterone receptor antagonists used to treat HF?
-reduce HF related morbidity and mortality
-generally reserved for class 3-4
-side effects= hyperkalemia and gynecomastia
What is gynecomastia?
Enlargement of breast tissue (usually in men)
How is digoxin used to treat HF?
-enhances inotrophy of cardiac muscle
-reduces activation of SNS and RAAS
-reduces symptoms, increases exercise tolerance, decreases risk of progression
How are beta blockers used to treat HF?
-cardioprotective effects due to blockade of excessive SNS stimulation
-short term= decreases myocardial contractility, increase in EF
-combined with HF therapy, reduce morbidity and mortality
What is cardiac resynchronisation therapy?
Increases efficiency by improving the co-ordination.
Have CRT device if moderate to severe HF, EF <35%
Therapy for Stage A?
-treat hypertension
-treat lipid disorders
-encourage regular exercise
-discourage alcohol intake
-ACE inhibition
Therapy for Stage B?
-All measures for A
-ACE inhibitors if appropriate
-beta- blockers if appropriate
Therapy for Stage C?
-All measures for A
-diuretics, ACE, beta blockers, digitalis, salt restriction
Therapy for Stage D?
-All under A, B and C
-mechanical assist devices (LVAD)
-heart transplantation
-continuous IV, inotropic infusions for palliation
