Heart Failure treatment Flashcards
define systolic heart failure
decreased pumping function of the heart, which results in fluid back up in the lungs and heart failure
define diastolic heart failure
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
What are the risk factors for heart failure
- diseases that effect the heart muscle
- anything that reduces blood supply to heart
- valve diseases
- arrhythmias
- Aortic stenosis
- previous MI
- Congenital
what mechanisms does the heart use as ‘compensation’ in HF
renin-aldosterone-angiotensin system
sympathetic system
enothelium system
what does activation of the RAAS system do
releases angiotensin II and aldosterone.
the result is salt and water retention, vasoconstriction and hypertrophy and fibrosis of cardio myocytes
what does activation of the sympathetic system do
releases noradrenaline and adrenaline.
results in vasconstriction which leads to myocyte hypertrophy
what are the two aims of heart failure treatment
improve symptoms
improve survival
what medications can be used to improve symptoms
diuretics
digoxin
ACEI/ARB
what medications can be used to improve survival
ACEI/ARB
B-Blockers
Ivabradine
Spironolactone
what does the medication Ivabradine do
acts by reducing the heart rate via specific inhibition of the funny channels
what are two loop diuretics (used in symptomatic treatment)
furosemide
bumetanide
why are B-blockers used in heart failure
they block detrimental hormonal changes caused by activation of the sympathetic system
improve L ejection fraction
name an ACEI
Ramipril
what does spironolactone do
blocks the effects of aldosterone ( therefore promotes sodium excretion)
what type of drug is Digoxin and what does it do
positive inotrope
improves the ability of the heart to pump
what is the mechanism of Hydrazaline
an arterial dilator
in diuretic resistant patients furosemide can be used in combination with thiazide diuretics this is powerful, what can be the adverse drug reactions
dehydration hypotension Hypokalaemia gout impaired glucose tolerance,
what drugs can frusemide interact with
antihypertensives-profound hypotension
vancomycin-renal toxicity
NSAIDs-renal toxicity
ACEI block angiotensin II production and therefore have what effect on preload and afterload
reduces both preload and afterload
what are adverse reactions of ACEI
cough first dose hypotension angioedema renal impair/failue hyperkalaemia
should beta blockers be prescribed for heart failure
only when used carefully and when patient is stable
why would you use Warfarin in HF treatment
if patient has a dilated ventricle this can give rise to a thrombus, warfarin has value in preventing this
what is Sacubitril-Valsartan
a combined ARB and Neprilysin
what is the mechanism of Sacubitril-Valsartan
- the ARB blocks AT1 receptor
- Neprilysin stops the break down of ANP and BNP
what type of antagonist is spironolactone
an aldosterone antagonist it inhibits the action of aldosterone
when is spironolactone particularly useful
in cases of resistant oedema
reduced mortality when used with ACEI
name a beta blocker used in heart failure
bisoprolol
in heart failure beta blockers should only be used when the patient is STABLE
what effect does Iabradine have on myocardial contractility
no effect
Ivabradine is a specific inhibitor of the If current in the sinoatrial node.
Digoxin is a positive inotrophic agent, what are weaknesses of this drug
no effect on mortality narrow therapeutic range arrhythmias nausea confusion
