Heart failure treatment Flashcards
What is the pathology in systolic heart failure
Decreased pumping function of the heart, which results in fluid back up in the lungs and heart failure
What is the pathology of diastolic heart failure
Involves a thickened and stiff heart muscle
so the heart does not fill with blood properly
resulting in fluid backup in the lungs and heart failure
What is the risk factors for heart failure
Coronary artery disease Hypertension (LVH) Valvular heart disease Alcoholism Infection (viral) Diabetes Congenital heart defects Age/smoking/obesity/ obstructive sleep apnea
How does systolic dysfunction get increasing worse
As the heart reduces its cardiac output due to loss of pumping ability - causes the heart to dilate ad decreases force of contraction which causes a further decrease in cardiac output
What does a decreased cardiac output in systolic dysfunction active,
RAAS activation
Sympathetic activation
What happens to the heart as it continues to dilate
cardiac myocytes undergo hypertrophy and then fibrosis and thus the heart is further weakened
What is the affect of RAAS and sympathetic activation
The result is salt and water retention, vasoconstriction
How does heart failure lead to oedema
RAAs activation causes salt and water retention increasing circulatory volume resulting in oedema
What is the different treatment methods of symptomatic treatment
Inhibition of detrimental neurohormonal adaptations
Enhancement of beneficial neurohormonal adaptations
Enhancement of cardiac function
What is the main symptomatic treatment in heart failure
Loop diuretics
FUROSEMIDE or BUMETANIDE
Inhibit the NA-K-Cl transporter in the Loop of Henle - remove excess salt and water
What treatment blocks the sympathetic activation in heart failure and examples
Beta blockers
CARVEDILOL, BISOPROLOL METOPROLOL
What are the two sets of drugs that block the affects of angiotensin II released in RAAS activation
ACE Inhibitors (Ramipril )
Angiotensin antagonists (Valsartan, Losartan)
What drug is a aldosterone antagonist
SPIRONOLACTONE
What beneficial hormonal change does drug treatment want to target in the treatment of heart failure and why>
Natriuretic peptide system
Atrial natriuretic and Brain peptides are potent natriuretic agents and vasododilators
What drug therapies enhance cardiac function in the treatment of heart failure
Positive iotropes:
Digoxin - improve the pumping ability of the heart
Vasodilators:
Isosorbide mononitrate/dinitrate: reduce preload and after load
What loop diuretic is more likely to be used in old age patients and why
Bumetanide - due to slow onset
What does it mean that loop diuretics work at very low glomerular filtration rates
Continue working if kidney becomes impaired
What can be used with loop diuretics if patients show a resistance
thiazide diuretics
What is loop diuretic and thiazide diuretic a short term treatment
due to the adverse drug reactions of;
Dehydration Hypotension Hypokalaemia, Hyponatraemia Gout Impaired glucose tolerance, diabetes
What is the main outcome of drug interactions with fursemide
Renal toxicity
due to aminoglycosides, lithium, NSAIDS, vancomysin
What drug therapies are used for reducing mortality in heart failure
Angiotensin Blockade
Beta receptor blockade
Aldosterone blockade
ANP/BNP enhancement
What is examples of angiotensin converting enzymes inhibitors ACEI and how do they work
RAMIPRIL, ENALAPRIL, LISINOPRIL
Prevent the conversion of angiotensin I to angiotensin II
Reduce preload and after load on the heart
What is the adverse drug reactions of ACE inhibitors
First dose hypotension Cough Angioedema Renal impairment Renal failure Hyperkalaemia
What drugs interact with ACE inhibitors to cause hyperkalaemia
Potassium supplements
Potassium sparing diuretics
What is the drug interaction caused by ACE inhibitor and NSAIDS
acute renal failure
How does Angiotensin receptors blockers work in the treatment of heart failure and when are they used
ARBs selectively block the angiotensin II, AT1 receptor.
In ACEI intolerant patients
What is the affect of blocking angiotensin 11 AT1 receptor
Prevent; Vasoconstriction Vascular proliferation Aldosterone secretion Cardiac myocyte proliferation Increased sympathetic tone
What is an example of a drug that prevents the break down of ANP and DNP therefore enhancing natural diuretics in the body
Neprolysin
How and where do Potassium sparing diuretic drugs work
interfering with the sodium-potassium exchange in the distal convoluted tubule in the kidneys
When are aldosterone antagonists particularly useful
In heart failure with resistant oedema
When should beta blockers be administrated in heart failure
Should be used only when a patient has been stabilized
and not during an acute presentation
do not give to patients with fluid retention Can cause further deterioration
How does the ivabradine reduce heart rate in the treatment of heart failure
reduces heart rate
specific inhibitor of the If current in the sinoatrial node.
What heart failure patients should be administered ivabradine
Only in patients with high hart rate above 70bpm
How does digoxin work in reducing the symptoms in heart failure
Increases availability of calcium in the myocyte - Therefore improving hearts pumping ability
= symptomatic
What is the adverse reactions cause by the narrow therapeutix index of digoxin
Arrhythmias
Nausea
Confusion
Why and when would digoxi treatment be offered
Offered to improve cardiac status near the end stage
avoided due to toxicity
Whys is warfarin anticoagulant used in heart failure treatment
Acts as a prevention of the formation of thromboembolic events
What is the full treatment regime in heart failure
Furosemide ± thiazide Furosemide ACE Inhibitor Angiotensin receptor blocker ARNI Beta-blocker ± Ivabradine MRA-spironolactone Digoxin Warfarin
How do you monitor the benefit of the treatment
Monitor weight regular to check fluid loss/retention
