Heart Failure Treatment

Question 1

define congestive heart failure

Answer 1

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

Question 2

define systolic heart failure

Answer 2

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

Question 3

define diastolic heart failure

Answer 3

thickened/stiff heart muscles resulting in the heart being unable to fill with blood properly. this results in fluid backup in the lungs and heart failure

Question 4

what are the risk factors for heart failure?

Answer 4

> coronary heart disease
> hypertension
> valvular heart disease
> alcoholism
> infection
> diabetes
> congenital heart defects

Question 5

what is the frank-starling law that is lost on heart failure?

Answer 5

if the muscle of a healthy heart is stretched it will contact with greater force and pump out more blood

Question 6

describe what changes occur to lead to systolic dysfunction heart failure

Answer 6

the circulatory volume increases dilating the heart and weakening the force of contraction dropping the cardiac output. as a result the RAAS is activating increasing the circulatory volume even more and further deteriorating cardiac performance. cardiac myocytes also then undergo hypertrophy and fibrosis further weakening the heart.

Question 7

what is the final result of the RAAS cycle in heart failure?

Answer 7

there is progressive retention of salt and water creating peripheral and pulmonary oedema. this leads to progressive myocyte death and fibrosis.

Question 8

what drugs improve symptoms of heart failure?

Answer 8

> diuretics

> digoxin

Question 9

what drugs improve survival of heart failure?

Answer 9

> beta blockers

> ivabradine

Question 10

what drugs improve symptoms and survival?

Answer 10

> ACE inhibitors
spironolactone
valsartan-sacubitril

Question 11

what do symptomatic treatment regimes target?

Answer 11

> inhibition of detrimental neuro-hormonal adaptions
enhancement of beneficial neuro-hormonal adaption
enhancement of cardiac function

Question 12

what drugs block sympathetic activation?

Answer 12

beta-blockers
> carvedilol
> bisoprolol
> metoprolol

Question 13

what two drugs groups block the effects of angiotensin 2?

Answer 13

> ACE inhibitors (Ramipril)

> angiotensin antagonists (valsartan, losartan)

Question 14

what blocks the effects of aldosterone?

Answer 14

spironolactone

Question 15

what metabolises ANPs and BNPs?

Answer 15

neutral endopeptidase

Question 16

what does the drug neprolysin do?

Answer 16

it enhances beneficial hormonal changes by preventing metabolism and enhancing the actions of ANP/BNP.

Question 17

what are the effects of positive inotropes?

Answer 17

they improve the ability of the heart to pump and so improve cardiac status (digoxin)

Question 18

what are the effects of vasodilators on cardiac function?

Answer 18

they improve cardiac function by reducing preload and after load

Question 19

give some examples of vasodilators used to treat heart failure

Answer 19

> nirtovasodilators: isosorbide mono, dinitrate

> hydralazine (arterial dilator)

Question 20

describe the actions of loop diuretic drugs

Answer 20

they removes excess slat and water by inducing profound diuresis. they inhibit the Na-K-CL transport in the loop of Henle and work at low glomerular filtration rates. they prevent reabsorption of 20% of filtered sodium and water.

Question 21

name a loop diuretic

Answer 21

furosemide

Question 22

what drugs can you use in diuretic resistant patients?

Answer 22

in combination with thiazide diuretics

Question 23

what are the adverse drug reactions associated with thiazide diuretics?

Answer 23

> dehydration
> hypotension
> hypokalaemia
> hyponatraemia
> gout
> impaired glucose tolerance

Question 24

what drugs does frusemide interact with to create renal toxicity?

Answer 24

> aminoglycosides
lithium
NSAIDs
vancomycin

Question 25

what does frusemide interact with to create hypotension?

Answer 25

anti-hypertensives

Question 26

what actions reduce mortality?

Answer 26

> angiotensin blockade > beta receptor blockade > aldosterone blockade > ANP/BNP enhancement

Question 27

name the pathways that generate angiotensin 2

Answer 27

> angiotensinogen converted by renin in the liver | > chymase pathway

Question 28

what effects does angiotensin 2 have on the heart?

Answer 28

> left ventricle hypertrophy > fibrosis > remodelling > apoptosis

Question 29

name three angiotensin converting enzyme inhibitors

Answer 29

> Ramipril > enalapril > lisinopril

Question 30

what do angiotensin converting enzyme inhibitors reduce?

Answer 30

the preload and afterload on the heart. morbidity and mortality of patients with CHF.

Question 31

what are the adverse drug reactions of ACE inhibitors?

Answer 31

``` > first dose hypotension > cough > angioedema > renal impairment > renal failure > hyperkalaemia ```

Question 32

what drug-drug interactions are there with ACE inhibitors?

Answer 32

> NSAIDs, acute renal failure > potassium supplements, hyperkalaemia > potassium sparing diuretics, hyperkalaemia

Question 33

what is the actions of angiotensin receptor blockers?

Answer 33

they selectively block the angiotensin 2, AT1 receptor.

Question 34

what are the roles of AT1 receptor?

Answer 34

``` > vasoconstriction > vascular proliferation > aldosterone secretion > cardiac myocyte proliferation > increased sympathetic tone ```

Question 35

what are the roles of AT2 receptors?

Answer 35

> vasodilation > anti-proliferation > apoptosis

Question 36

what is valsartan-sacubitril?

Answer 36

it is combined valsartan and ARB and neprilysin

Question 37

what is the action of spironolactone?

Answer 37

this is a potassium sparing diuretic which acts in the distal tube, inhibiting the actions of aldosterone.

Question 38

name three beta-blockers

Answer 38

> carvedilol > bisoprolol > metoprolol

Question 39

when should beta blocker be used?

Answer 39

when the patient has been stabilised as they block the actions of the sympathetic system not to be used in acute presentation.

Question 40

what does ivabradine inhibit?

Answer 40

If current in the sinoatrial node

Question 41

to which patients is ivabradine given?

Answer 41

symptomatic stable chronic HFrEF who are receiving standard therapy including beta blocker at maximum tolerated dose and who are sinus rhythm with a heart rate of 70bpm or greater

Question 42

what is the action of digoxin?

Answer 42

it increases the availability of calcium in the myocyte

Question 43

what events does warfarin help prevent?

Answer 43

thrombus formation and thrombo-embolic events caused by dilated ventricles.

Question 44

what is monitored to monitor benefit of treatment?

Answer 44

> symptomatic relief > clinical relief > weight > patient education