Heart Failure treatment

Question 1

define systolic heart failure

Answer 1

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

Question 2

define diastolic heart failure

Answer 2

involves a thickened and stiff heart muscle. As a result the heart does not fill with blood properly. results in fluid back in the lungs and heart failure

Question 3

What are the risk factors for heart failure

Answer 3

1. diseases that effect the heart muscle
2. anything that reduces blood supply to heart
3. valve diseases
4. arrhythmias
5. Aortic stenosis
6. previous MI
7. Congenital

Question 4

what mechanisms does the heart use as ‘compensation’ in HF

Answer 4

renin-aldosterone-angiotensin system
sympathetic system
enothelium system

Question 5

what does activation of the RAAS system do

Answer 5

releases angiotensin II and aldosterone.

the result is salt and water retention, vasoconstriction and hypertrophy and fibrosis of cardio myocytes

Question 6

what does activation of the sympathetic system do

Answer 6

releases noradrenaline and adrenaline.

results in vasconstriction which leads to myocyte hypertrophy

Question 7

what are the two aims of heart failure treatment

Answer 7

improve symptoms

improve survival

Question 8

what medications can be used to improve symptoms

Answer 8

diuretics
digoxin
ACEI/ARB

Question 9

what medications can be used to improve survival

Answer 9

ACEI/ARB
B-Blockers
Ivabradine
Spironolactone

Question 10

what does the medication Ivabradine do

Answer 10

acts by reducing the heart rate via specific inhibition of the funny channels

Question 11

what are two loop diuretics (used in symptomatic treatment)

Answer 11

furosemide

bumetanide

Question 12

why are B-blockers used in heart failure

Answer 12

they block detrimental hormonal changes caused by activation of the sympathetic system

improve L ejection fraction

Question 13

name an ACEI

Answer 13

Ramipril

Question 14

what does spironolactone do

Answer 14

blocks the effects of aldosterone ( therefore promotes sodium excretion)

Question 15

what type of drug is Digoxin and what does it do

Answer 15

positive inotrope

improves the ability of the heart to pump

Question 16

what is the mechanism of Hydrazaline

Answer 16

an arterial dilator

Question 17

in diuretic resistant patients furosemide can be used in combination with thiazide diuretics this is powerful, what can be the adverse drug reactions

Answer 17

dehydration 
hypotension
Hypokalaemia
gout 
impaired glucose tolerance,

Question 18

what drugs can frusemide interact with

Answer 18

antihypertensives-profound hypotension
vancomycin-renal toxicity
NSAIDs-renal toxicity

Question 19

ACEI block angiotensin II production and therefore have what effect on preload and afterload

Answer 19

reduces both preload and afterload

Question 20

what are adverse reactions of ACEI

Answer 20

cough
first dose hypotension 
angioedema 
renal impair/failue
hyperkalaemia

Question 21

should beta blockers be prescribed for heart failure

Answer 21

only when used carefully and when patient is stable

Question 22

why would you use Warfarin in HF treatment

Answer 22

if patient has a dilated ventricle this can give rise to a thrombus, warfarin has value in preventing this

Question 23

what is Sacubitril-Valsartan

Answer 23

a combined ARB and Neprilysin

Question 24

what is the mechanism of Sacubitril-Valsartan

Answer 24

• the ARB blocks AT1 receptor

- Neprilysin stops the break down of ANP and BNP

Question 25

what type of antagonist is spironolactone

Answer 25

an aldosterone antagonist it inhibits the action of aldosterone

Question 26

when is spironolactone particularly useful

Answer 26

in cases of resistant oedema

reduced mortality when used with ACEI

Question 27

name a beta blocker used in heart failure

Answer 27

bisoprolol

in heart failure beta blockers should only be used when the patient is STABLE

Question 28

what effect does Iabradine have on myocardial contractility

Answer 28

no effect

Ivabradine is a specific inhibitor of the If current in the sinoatrial node.

Question 29

Digoxin is a positive inotrophic agent, what are weaknesses of this drug

Answer 29

no effect on mortality
narrow therapeutic range
arrhythmias
nausea
confusion