heart failure treatment

Question 1

what is chronic heart failure characterised by?

Answer 1

progressive cardiac dysfunction
breathlessness
tiredness
neurohormonal disturbances 
sudden death

Question 2

what is heart failure?

Answer 2

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

Question 3

what are the different types of heart failure?

Answer 3

Systolic heart failure (HFrEF)

diastolic heart failure

Question 4

what is systolic heart failure

Answer 4

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

Question 5

what is diastolic heart failure

Answer 5

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

Question 6

how many people does chronic heart failure effect?

Answer 6

2-10%

Question 7

what are risk factors for heart failure?

Answer 7

coronary artery disease
hypertension
diabetes
congenital heart defects
valvular heart disease
alcoholism

other-
obesity
age
smoking
obstructive sleep apnea

Question 8

whats the number 1 risk for heart failure?

Answer 8

hypertension

Question 9

what is the Frank-starling law?

Answer 9

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

Question 10

what happens in systolic dysfunction?

Answer 10

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

Question 11

when is RAAS activated in systolic dysfunction

Answer 11

when cardiac output is decreased

Question 12

what happens to cardiac performance and circulatory volume when RAAS is activated?

Answer 12

circulatory volume increases and cardiac performance deteriorates further

Question 13

how does fibrosis occur when heart starts to dilate from RAAS?

Answer 13

cardiac myocytes undergo hypertrophy and then fibrosis and thus the heart is further weakened

Question 14

why does heart failure usually occur?

Answer 14

following sustained hypertesion

following myocardial damage

Question 15

what does the activation of the sympathetic system cause the release of?

Answer 15

vasoconstriction
stimulate renin release
myocyte hypertrophy

Question 16

what kind of system is salt and water excretion and vasodilation?

Answer 16

natriuretic peptide system ANP/BNP

Question 17

what does the progressive retention of salt and water results in?

Answer 17

oedema and pulmonary oedema

Question 18

what are the aims of treatment for people with heart failure?

Answer 18

improve symptoms

improve survival

Question 19

what treatment would you use to improve the symptoms?

Answer 19

diuretics

digoxin

Question 20

what treatment would you use to improve symptoms and survival?

Answer 20

ACE inhibitors
spironolactone
valsartan-sacubitril

Question 21

what treatment would you use to improve survival?

Answer 21

beta blockers and ivabradine

Question 22

what are the aims of symptomatic treatment?

Answer 22

inhibition of detrimental neurohormonal adaptations

enhanceent of beneficial neurohoronal adaptations

enhancement of cardiac function

Question 23

what is the systematic treatment?

Answer 23

loop diuretics

furosemide or bumetanide

Question 24

what system enhances beneficial hormonal changes?

Answer 24

natriuretic peptide system

ANP/BNP

Question 25

what would you use for enhancement of cardiac function?

Answer 25

positive ionotropes- Digoxin vasodilators- reduces preload and after load improve cardiac function

Question 26

how much does ace inhibitors effect mortality?

Answer 26

35%

Question 27

how much does beta blockers effect mortality?

Answer 27

38%

Question 28

which drug removes salt and water?

Answer 28

loop diuretcs- furosemide

Question 29

do loop diuretics work at low or high glomerular filtration rates

Answer 29

low

Question 30

what are adverse drug reactions of loop diuretics?

Answer 30

``` dehydration hypotension hypokalaemia gout impaired glucose tolerance ```

Question 31

what drug to drug reactions do you get when you combine frusemide and aminoglycosides?

Answer 31

aural and renal toxicity

Question 32

what drug to drug reactions do you get when you combine frusemide and lithium?

Answer 32

renal toxicity

Question 33

what drug to drug reactions do you get when you combine frusemide and NSAIDs?

Answer 33

renal toxicity

Question 34

what drug to drug reactions do you get when you combine frusemide and antihypertensives?

Answer 34

profound hypertension

Question 35

what drug to drug reactions do you get when you combine frusemide and vancomycin?

Answer 35

renal toxicity

Question 36

what 4 things would you give/do to reduce mortality?

Answer 36

angiotensin blockade beta receptor blockade aldosterone blockade ANP/BNP enhancement

Question 37

what are the ace inhibitors?

Answer 37

Rampipril, enalapril, lisinopril

Question 38

what are adverse drug reactions with ACE inhibitors?

Answer 38

``` First dose hypotension Cough Angioedema Renal impairment Renal failure Hyperkalaemia ```

Question 39

what are drug to drug reactions in combination with ACE inhibitors and NSAIDs?

Answer 39

acute renal failure

Question 40

what are drug to drug reactions in combination with ACE inhibitors and potassium supplements

Answer 40

hyperkalaemia

Question 41

what are the different roles of AT1 and AT2

Answer 41

``` AT1- Vasoconstriction Vascular proliferation Aldosterone secretion Cardiac myocyte proliferation Increased sympathetic tone ``` AT2- vasodilation antiproliferation apoptosis

Question 42

what is valsartan-sacubitril (ARNI)?

Answer 42

combined valsartan and ARB and neprilysin

Question 43

does ARB block AT1 or AT2 receptor?

Answer 43

AT1

Question 44

what does neprilysin stop the break down of

Answer 44

ANP and BNP by neutral endopeptidases

Question 45

alsosterone antagonist and ehat is proven to reduce mortality?

Answer 45

ACEi

Question 46

is the use of beta blockers in the treatment of chronic heart failure hazardous?

Answer 46

potentially, patients must be selected carefully

Question 47

what are the function of beta blockers?

Answer 47

block the action of the sympathetic system

Question 48

what is ivabradine?

Answer 48

ivabradine is a specific inhibitor of the If current in the sinatrial node