heart failure treatment Flashcards
what are the characteristics of chronic heart failure?
- progressive cardiac dysfunction
- dyspnoea
- tiredness
- neurohormonal disturbances
- sudden death
what is systolic heart failure (HFrEF)?
heart fialure reduced ejection fraction.Decreased pumping function of the heart, which results in fluid back up in the lungs and heart failure
describe the pathophysiology of diastolic heart failure (HFpEF)?
- a thickened and stiff heart muscle
- heart does not fill with blood properly as compliance decreases
- this results in fluid backup in the lungs and heart failure
what are the risk factors for heart failure?
coronary artery disease hypertension valvular heart disease alcoholism infection (viral) diabetes congenital herat defects obesity age smoking obstructive sleep apnoea high or low haematocrit
describe the pathophysiology of systolic dysfunction heart failure?
- failing or damaged heart causes it to not follow Starling’s law
- so cardiac outpt decreases
- this activates RAAS and synathetis system and circulatory volume increases and vasoconstriction
- this causes further dilation of the heart so CO drops further as the myocytes hypertrophy and then fibrose
- RAAS activarted again and so on.
what are the treatments just for the symptoms of heart failure?
diuretics
digoxin
what are the treatments for heart failure that both treat symptoms and increase survival?
ACEi/ARBs
spironolactone
valsartan-sacubitril
what are the treatments for herat failure that just improve survival?
Beta Blockers
Ivabradine
whar are the diuretics used for the treatment of symtpoms of heart failure?
loop diuretics such as furosemide and Bumetanide (used in elderly as slower effects)
which Beta Blockers are used to block detrimental hormonal changes (adrenaline) in heart failure?
bisoprolol
carvedilol
metoprolol (in trials but not used )
which 2 groups of drugs are available for the blocking of angiotensin II effects in heart failure? and give examples
ACEi- ramipril
ARBs- valsartan, losartan
which drugs out of ACEi and ARBs are most effective?
ACEi
what are the drugs that block the effects of aldosterone in heart failure?
potassium sparing diuretics such as spironolactone
what is the mode of action of neprolysin for improving heart failure?
prevents metabolism of ANP and BNP and enhances their actions
what is the mode of action of digoxin for improving heart failure?
improves the ability of the heart to pump and so improve cardiav status
what is the action of isosorbide mono and dinitrate for improving herat failure?
vasodilators reducing preload and afterload.
what is the action of hydralazine in the treatment of heart failue?
arterial dilator which improved cardiac function
what is the action of furosemide in the treatment of heart failure?
loop diuretic so removes excess salt and water
when heart failure patients are resistant to loop diuretics such as furozemide what is added to the treatment?
thiazide diuretics
what are the adverese drug reactions of furozemide?
dehydration hypotension hypokalaemia hyponatraemia gout impaired glucose tolerance, diabetes
which drugs does furosemide interact with?
antihypertensives- causes cause renal toxicity: profound hypotension aminoglycosides lithium NSAIDs vancomycin
what are the 4 ways to reduce mortality in heart failure?
Angiotensin Blockade
Beta receptor blockade
Aldosterone blockade
ANP/BNP enhancement
name 3 ACEi?
ramipril
enalalpril
lisinopril
what are the adverse drug reactions of ACEI?
first dose hypotension angioedema renal impairment renal faliure hyperkalaemia
what drugs do ACEI interact with? and what do they cause when given together?
NSAIDs - acute renal failure
potassium supplements-hyperkalaemia
potassium sparing diuretics-hyperkalaemia
what is the mode of action of valsartan-sacubitril (ARNI)?
it is a combined vasartan and ARB and naprilysin drug, so blocks the angiotensin II receptor prevents the break down of ANP and BNP
when are Beta Blockers used in the treatment of herat failure and why?
only used after patient is stabilised and “dry”. Unstabe patients rely on a sympathetic drive so if given a beta blocker this drive willl be lost.
what is the action of ivabradine?
inhibitor of the If current in the sinoatrial node so reduces heart rate, it has no effect on myocardial conteactility
what are the sideeffects of digoxin?
arrhthmias
nausea
confusion
what anticoagulant is used in heary failure?
warfarin
what are the treatments for heart failure?
furozemide ± thiazide furosemide + metolazone ACEi ARB ARNI-valsartin-sacubtril Beta-blocker ± ivabradine spironolactone digoxin warfarin
