heart failure treatment

Question 1

what are the characteristics of chronic heart failure?

Answer 1

• progressive cardiac dysfunction
• dyspnoea
• tiredness
• neurohormonal disturbances
• sudden death

Question 2

what is systolic heart failure (HFrEF)?

Answer 2

heart fialure reduced ejection fraction.Decreased pumping function of the heart, which results in fluid back up in the lungs and heart failure

Question 3

describe the pathophysiology of diastolic heart failure (HFpEF)?

Answer 3

• 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

Question 4

what are the risk factors for heart failure?

Answer 4

coronary artery disease
hypertension
valvular heart disease
alcoholism
infection (viral)
diabetes
congenital herat defects
obesity 
age
smoking
obstructive sleep apnoea
high or low haematocrit

Question 5

describe the pathophysiology of systolic dysfunction heart failure?

Answer 5

• 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.

Question 6

what are the treatments just for the symptoms of heart failure?

Answer 6

diuretics

digoxin

Question 7

what are the treatments for heart failure that both treat symptoms and increase survival?

Answer 7

ACEi/ARBs
spironolactone
valsartan-sacubitril

Question 8

what are the treatments for herat failure that just improve survival?

Answer 8

Beta Blockers

Ivabradine

Question 9

whar are the diuretics used for the treatment of symtpoms of heart failure?

Answer 9

loop diuretics such as furosemide and Bumetanide (used in elderly as slower effects)

Question 10

which Beta Blockers are used to block detrimental hormonal changes (adrenaline) in heart failure?

Answer 10

bisoprolol
carvedilol
metoprolol (in trials but not used )

Question 11

which 2 groups of drugs are available for the blocking of angiotensin II effects in heart failure? and give examples

Answer 11

ACEi- ramipril

ARBs- valsartan, losartan

Question 12

which drugs out of ACEi and ARBs are most effective?

Answer 12

ACEi

Question 13

what are the drugs that block the effects of aldosterone in heart failure?

Answer 13

potassium sparing diuretics such as spironolactone

Question 14

what is the mode of action of neprolysin for improving heart failure?

Answer 14

prevents metabolism of ANP and BNP and enhances their actions

Question 15

what is the mode of action of digoxin for improving heart failure?

Answer 15

improves the ability of the heart to pump and so improve cardiav status

Question 16

what is the action of isosorbide mono and dinitrate for improving herat failure?

Answer 16

vasodilators reducing preload and afterload.

Question 17

what is the action of hydralazine in the treatment of heart failue?

Answer 17

arterial dilator which improved cardiac function

Question 18

what is the action of furosemide in the treatment of heart failure?

Answer 18

loop diuretic so removes excess salt and water

Question 19

when heart failure patients are resistant to loop diuretics such as furozemide what is added to the treatment?

Answer 19

thiazide diuretics

Question 20

what are the adverese drug reactions of furozemide?

Answer 20

dehydration
hypotension
hypokalaemia
hyponatraemia
gout
impaired glucose tolerance, diabetes

Question 21

which drugs does furosemide interact with?

Answer 21

antihypertensives- causes cause renal toxicity:
profound hypotension
aminoglycosides
lithium
NSAIDs
vancomycin

Question 22

what are the 4 ways to reduce mortality in heart failure?

Answer 22

Angiotensin Blockade
Beta receptor blockade
Aldosterone blockade
ANP/BNP enhancement

Question 23

name 3 ACEi?

Answer 23

ramipril
enalalpril
lisinopril

Question 24

what are the adverse drug reactions of ACEI?

Answer 24

first dose hypotension
angioedema
renal impairment
renal faliure
hyperkalaemia

Question 25

what drugs do ACEI interact with? and what do they cause when given together?

Answer 25

NSAIDs - acute renal failure
potassium supplements-hyperkalaemia
potassium sparing diuretics-hyperkalaemia

Question 26

what is the mode of action of valsartan-sacubitril (ARNI)?

Answer 26

it is a combined vasartan and ARB and naprilysin drug, so blocks the angiotensin II receptor prevents the break down of ANP and BNP

Question 27

when are Beta Blockers used in the treatment of herat failure and why?

Answer 27

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.

Question 28

what is the action of ivabradine?

Answer 28

inhibitor of the If current in the sinoatrial node so reduces heart rate, it has no effect on myocardial conteactility

Question 29

what are the sideeffects of digoxin?

Answer 29

arrhthmias
nausea
confusion

Question 30

what anticoagulant is used in heary failure?

Answer 30

warfarin

Question 31

what are the treatments for heart failure?

Answer 31

furozemide ± thiazide
furosemide + metolazone
ACEi
ARB
ARNI-valsartin-sacubtril
Beta-blocker ± ivabradine
spironolactone
digoxin
warfarin