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Cardiovascular > Heart Failure - treatment > Flashcards

Heart Failure - treatment Flashcards

1
Q

What is chronic heart failure characterised by?

A 
Progressive cardiac dysfunction 
Breathlessness 
Tiredness 
Neurohormonal disturbance 
Sudden death
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2
Q

What is heart failure?

A

The state in which the heart is unable to pump blood at a rate commensurate with the requirements of the tissues or can do so only from high pressures

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3
Q

What are the two types of heart failure?

A

Systolic heart failure (HFrEF)

Diastolic heart failure (HFpEF)

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4
Q

What is systolic heart failure?

A

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

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5
Q

What is diastolic heart failure?

A

A thickened and stiff heart that does not fill with blood properly which results in fluid backup in the lungs and heart failure

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6
Q

What are the risk factors for heart failure?

A 
Coronary artery disease 
Hypertension 
Valvular heart disease 
Alcoholism 
Infection 
Diabetes 
Congenital heart defects 
Obesity 
Age 
Smoking 
High or low hematocrit level 
Obstructive sleep apnea
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7
Q

What is the number one risk for heart failure?

A

Hypertension

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8
Q

What is the pathological progression of cardiovascular disease?

A

Myocardial injury
Pathological remodelling
Low ejection fraction
Death

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9
Q

How does systolic dysfunction cause heart failure?

A

The heart can no longer pump out blood properly
As circulatory volume increases, the heart dilates, force of contraction weakens and cardiac output drops
Decreased cardiac output activates the RAAS further
This continuous to happen: RAAS activated, circulatory volume increases and cardiac performance decreases
Dilation of the heart causes hypertrophy of cardiac myocytes and then fibrosis

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10
Q

What are the two reasons for heart failure?

A

Sustained hypertension

Myocardial damage

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11
Q

What happens during heart failure?

A

Cardiac output falls
This is registered as decreased circulatory volume
Vasoconstrictor systems activate
RAAS activates

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12
Q

What does the RAAS do?

A

Retains salt and water

Peripheral vasoconstriction

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13
Q

What does the RAAS cause the release of?

A

Angiotensin II

Aldosterone

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14
Q

What does activation of the sympathetic system release?

A

Noradrenaline

Adrenaline

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15
Q

What does activation of the sympathetic system do?

A

Vasoconstriction
Renin release
Myocyte hypertrophy

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16
Q

What do atrial and brain natriuretic peptides do?

A

Vasodilation

Sodium excretion in the urine

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17
Q

How is salt and water excretion and vasodilation achieved?

A

Natriuretic peptide system

EDRF

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18
Q

What is the result of heart failure?

A

Heart that can’t pump blood sufficiently
Retention of salt and water resulting in pulmonary oedema
Myocyte death and fibrosis

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19
Q

What are the goals of heart failure management?

A

Improve symptoms

Improve survival

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20
Q

What medication is used to improve symptoms?

A

Diuretics

Digoxin

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21
Q

What medication is used to improve symptoms and survival?

A

ACE inhibitors/ARBs
Spironolactone
Valsartan-sacubitral

22
Q

What medication is used to improve survival?

A

Beta blockers

Ivabradine

23
Q

What is the treatment regime followed for heart failure?

A

Symptomatic treatment
Inhibition of detrimental neurohormonal adaptations
Enhancement of beneficial neurohormonal adaptations
Enhancement of cardiac function

24
Q

What is involved in symptomatic treatment?

A

Loop diuretics
Mainstay of symptomatic treatment
Furosemide or Bumetanide

25
Q

What is involved in blocking detrimental hormonal changes?

A

Sympathetic activation using beta blockers such as Carvedilol, Bisoprolol and Metoprolol

26
Q

How are the effects of angiotensin II blocked?

A

ACE inhibitors such as Ramipril

Angiotensin antagonists such as Valsartan and Losartan

27
Q

How are the effects of aldosterone blocked?

A

Spironolactone

28
Q

How are the beneficial hormonal changes enhanced?

A

Natriuretic peptide system - ANP/BNP

Neprolysin prevents metabolism and enhances ANP/BNP action

29
Q

How is cardiac function enhanced?

A

Positive inotropes - improve hearts ability to pump such as Digoxin
Vasodilators - nitrovasodilators reduce preload and afterload and atrial dilators have been shown to improve cardiac function too

30
Q

Nam some nitrovasodilators

A

Isosorbide mono

Dinitrate

31
Q

Name an atrial dilator

A

Hydralazine

32
Q

What do loop diuretics do?

A

Remove excess salt and water

33
Q

What are the adverse drug reactions for loop diuretics?

A 
Dehydration 
Hypotension 
Hypokalaemia 
Hyponatraemia 
Gout 
Impaired glucose tolerance 
Diabetes
34
Q

What should frusemide not be used with?

A 
Amino glycosides 
Lithium 
NSAIDs 
Antihypertensives 
Vancomycin
35
Q

What do ACE inhibitors do?

A

Prevent conversion of angiotensin I into angiotensin II

Reduce preload and after load to the heart

36
Q

What do ACE inhibitors reduce in post MI patients?

A

Morbidity
Mortality
Onset of heart failure

37
Q

What are the adverse drug reactions of ACE inhibitors?

A 
First dose hypotension 
Cough 
Angioedema 
Renal impairment 
Renal failure 
Hyperkalaemia
38
Q

What drugs should not be used with ACE inhibitors?

A

NSAIDs
Potassium supplements
Potassium sparing diuretics

39
Q

What do ARBs do?

A

Selectively block the angiotensin II, AT1 receptors

40
Q

When are ARBs used?

A

In ACE inhibitor intolerant patients

41
Q

What are the roles of the AT1 receptor?

A 
Vasoconstriction 
Vascular proliferation 
Aldosterone secretion 
Cardiac myocyte proliferation 
Increased sympathetic tone
42
Q

What are the roles of AT2?

A

Vasodilation
Antiproliferation
Apoptosis

43
Q

What is Valsartan-Sacubitril?

A

Combined valsartan, ARB and Neprilysin

44
Q

What does Valsartan-Sacubitril do?

A

Blocks AT1 receptors

Stops breakdown of ANP and BNP

45
Q

How should aldosterone antagonists be used?

A

In combination with ACE inhibitors if possible

46
Q

What do beta blockers do?

A

Block the action of the sympathetic system

47
Q

When should beta blockers be used?

A

When the patient has been selected by a specialist after they have been stabilised

48
Q

What does Digoxin do?

A

Increases the availability of calcium in the myocytes

49
Q

What negative effects can digoxin have?

A

Arrhythmias
Nausea
Confusion

50
Q

What is monitored to see how the patient is reacting to heart failure management?

A

Symptomatic relief
Clinical relief
Weight
Patient education

51
Q

What is monitored in symptomatic relief?

A

Shortness of breath
Tiredness
Lethargy

52
Q

What is monitored in clinical relief?

A

Peripheral oedema
Ascites
Weight

Cardiovascular (34 decks)

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