Heart Failure Treatment Flashcards
Chronic heart failure is a syndrome characterised by what?
Progressive cardiac dysfunction Breathlessness Tiredness Neurohormonal disturbances Sudden death
What are the types of heart failure and their features?
Systolic HF - decreased pumping function of the heart which results in fluid back-up in the lungs and heart failure
Diastolic HF - involves a thickened and stiff heart muscle, as a result the heart does not fill up with blood properly which results in fluid back-up in the lungs and heart
What percentage of the population are affected by chronic heart failure?
2-10%
What is the 5-year mortality of heart failure?
50%, rising to 80% in a year for some patients
What are the risk factors for heart failure?
Coronary artery disease Hypertension Valvular heart disease Alcoholism Infection Diabetes Congenital heart defects Obesity Age Smoking High or low haematocrit level Obstructive sleep apnoea
What is the basic pathological progression of cardiovascular disease?
Cause/risk factor
Myocardial injury, neurohormonal stimulation and myocardial toxicity
Pathological remodelling
Low ejection fraction, resulting in symptoms (dyspnoea, fatigue, oedema etc.)
Chronic heart failure
What is involved in neuroendocrine activation in heart failure?
Salt and water retention
Activation of: RAAS Sympathetic system Endothelin system Natriuretic peptide system ANP/BNP EDRF
What are the two main aims of treatment for heart failure?
To improve symptoms
To improve survival
What are the types of treatment regimens for heart failure?
Inhibition of neurohormonal adaptations
Enhancement of beneficial neurohormonal adaptations
Enhancement of cardiac function
What drugs are used for symptomatic heart failure treatment?
Diuretics
Digoxin
ACE inhibitors/ARBs
How do loop diuretics treat heart failure?
Removes excess salt and water - induce profound diuresis
Inhibit the Na-K-CL transporter in the loop of Henle
Prevent reabsorption of 20% of filtered sodium and water
Work at low glomerular filtration rates
What can be used in diuretic resistant patients?
A combination of thiazide diuretics
What are the potential adverse drug reactions of loop diuretics?
Dehydration Hypotension Hypokalaemia Hyponatraemia Gout Impaired glucose tolerance/diabetes
What are the potential drug-drug interactions of loop diuretics?
Furosemide and aminoglycosides - aural and renal toxicity
Furosemide and lithium - renal toxicity
Furosemide and NSAIDs - renal toxicity
Furosemide and anti-hypertensives - profound hypotension
Furosemide and vancomycin - renal toxicity
What drugs are used to block the effects of angiotensin II in the RAAS?
ACEIs e.g. ramipril
Angiotensin antagonists e.g. valsartan, losartan
What drug can be used to block the effects of aldosterone?
Spironolactone
What is the risk reduction carried by ACEIs?
35%
What pathophysiologies do ACEIs interfere with?
Pathophysiology of coronary ischaemia and renal insufficiency
Give examples of ACEIs
Ramipril
Enalapril
Lisinopril
How do ACEIs work?
Competitively block angiotensin converting enzyme to prevent the conversion of angiotensin I to angiotensin II
Reduce preload and afterload on the heart
What effect do ACEIs have on CHF patients?
Significantly reduce morbidity and mortality
What effect do ACEIs have on post-MI patients?
Reduce morbidity, mortality and onset of HF
What are the potential adverse drug reactions of ACEIs?
First dose hypotension Cough Angioedema Renal impairment Renal failure Hyperkalaemia
What are the potential drug-drug interactions of ACEIs?
NSAIDs - acute renal failure
Potassium supplements - hyperkalaemia
Potassium sparing diuretics - hyperkalaemia
