heart failure treatment Flashcards
what is chronic heart failure characterised by?
progressive cardiac dysfunction breathlessness tiredness neurohormonal disturbances sudden death
what is heart failure?
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
what are the different types of heart failure?
Systolic heart failure (HFrEF)
diastolic heart failure
what is systolic heart failure
decreased pumping function of the heart, which results in fluid back up in the lungs and heart failure
what is diastolic heart failure
involves a thickened and stiff heart muscle
as a result, the heart does not fill with blood properly
this results in fluid back up in the lungs and heart failure
how many people does chronic heart failure effect?
2-10%
what are risk factors for heart failure?
coronary artery disease hypertension diabetes congenital heart defects valvular heart disease alcoholism
other- obesity age smoking obstructive sleep apnea
whats the number 1 risk for heart failure?
hypertension
what is the Frank-starling law?
if the muscle of a healthy heart is stretched it will contract with greater force and pump out more blood
what happens in systolic dysfunction?
in the failing or damaged heart this relationship is lost
as circulatory volume increases the heart dilates, the force of contraction weakens and cardiac output drops further
when is RAAS activated in systolic dysfunction
when cardiac output is decreased
what happens to cardiac performance and circulatory volume when RAAS is activated?
circulatory volume increases and cardiac performance deteriorates further
how does fibrosis occur when heart starts to dilate from RAAS?
cardiac myocytes undergo hypertrophy and then fibrosis and thus the heart is further weakened
why does heart failure usually occur?
following sustained hypertesion
following myocardial damage
what does the activation of the sympathetic system cause the release of?
vasoconstriction
stimulate renin release
myocyte hypertrophy
what kind of system is salt and water excretion and vasodilation?
natriuretic peptide system ANP/BNP
what does the progressive retention of salt and water results in?
oedema and pulmonary oedema
what are the aims of treatment for people with heart failure?
improve symptoms
improve survival
what treatment would you use to improve the symptoms?
diuretics
digoxin
what treatment would you use to improve symptoms and survival?
ACE inhibitors
spironolactone
valsartan-sacubitril
what treatment would you use to improve survival?
beta blockers and ivabradine
what are the aims of symptomatic treatment?
inhibition of detrimental neurohormonal adaptations
enhanceent of beneficial neurohoronal adaptations
enhancement of cardiac function
what is the systematic treatment?
loop diuretics
furosemide or bumetanide
what system enhances beneficial hormonal changes?
natriuretic peptide system
ANP/BNP
what would you use for enhancement of cardiac function?
positive ionotropes- Digoxin
vasodilators- reduces preload and after load improve cardiac function
how much does ace inhibitors effect mortality?
35%
how much does beta blockers effect mortality?
38%
which drug removes salt and water?
loop diuretcs- furosemide
do loop diuretics work at low or high glomerular filtration rates
low
what are adverse drug reactions of loop diuretics?
dehydration hypotension hypokalaemia gout impaired glucose tolerance
what drug to drug reactions do you get when you combine frusemide and aminoglycosides?
aural and renal toxicity
what drug to drug reactions do you get when you combine frusemide and lithium?
renal toxicity
what drug to drug reactions do you get when you combine frusemide and NSAIDs?
renal toxicity
what drug to drug reactions do you get when you combine frusemide and antihypertensives?
profound hypertension
what drug to drug reactions do you get when you combine frusemide and vancomycin?
renal toxicity
what 4 things would you give/do to reduce mortality?
angiotensin blockade
beta receptor blockade
aldosterone blockade
ANP/BNP enhancement
what are the ace inhibitors?
Rampipril, enalapril, lisinopril
what are adverse drug reactions with ACE inhibitors?
First dose hypotension Cough Angioedema Renal impairment Renal failure Hyperkalaemia
what are drug to drug reactions in combination with ACE inhibitors and NSAIDs?
acute renal failure
what are drug to drug reactions in combination with ACE inhibitors and potassium supplements
hyperkalaemia
what are the different roles of AT1 and AT2
AT1- Vasoconstriction Vascular proliferation Aldosterone secretion Cardiac myocyte proliferation Increased sympathetic tone
AT2-
vasodilation
antiproliferation
apoptosis
what is valsartan-sacubitril (ARNI)?
combined valsartan and ARB and neprilysin
does ARB block AT1 or AT2 receptor?
AT1
what does neprilysin stop the break down of
ANP and BNP by neutral endopeptidases
alsosterone antagonist and ehat is proven to reduce mortality?
ACEi
is the use of beta blockers in the treatment of chronic heart failure hazardous?
potentially, patients must be selected carefully
what are the function of beta blockers?
block the action of the sympathetic system
what is ivabradine?
ivabradine is a specific inhibitor of the If current in the sinatrial node
