Heart failure treatment Flashcards
when does R heart failure only commonly occur?
in severe lung disease
not likely to be asked about in cardiovascular system question
heart failure tends to refer to LV heart disease
two types of heart failure?
systolic and diastolic
systolic heart failure (HFrEF - heart failure reduced ejection fraction)
heart has turned into a skinny bag that cannot function properly
Decreased pumping function of the heart, which results in fluid back up in the lungs and heart failure
LVSD
usually occurs following myocardial damage ie post MI
diastolic heart failure (HFpEF - Heart Failure with a Preserved Ejection Fraction ie it is normal)
Involves a thickened and stiff heart muscle due to high BP
As a result, the heart releases all the blood but it does not fill with blood properly as it can’t relax properly
This results in fluid backup in the lungs and heart failure
heart failure usually occurs following sustained hypertension
Chronic heart failure
2-10% of population affected
People with severe heart failure are very symptomatic – QOL affected greatly.
Peripheral oedema, if severe, can reduce mobility
risk factors for heart failure
Coronary artery disease previous MI Hypertension (LVH) Valvular heart disease Alcoholism – v common cause Infection (viral) diabetes congenital heart defects
then general:- age, obesity, smoking, obstructive sleep apnoea
what is the most severe risk factor of heart failure
hypertension
LV diastolic dysfunction can be prevented if hypertension is tackled aggressively
frank starling law and systolic dysfunction?
if the muscle of a healthy heart is stretched it will contract with greater force and pump out more blood.
Failing or damaged heart - lose this relationship
Healthy heart – contraction force is in proportion with the amount it is stretched
Damaged heart - More you stretch the heart due to increased circulatory volume (H20 and salt retention) the weaker the force of contraction and CO drops further
drop in CO activates vasoconstrictor system (sympathetic) and RAAS
how does a drop in CO due to HF cause further problems?
drop in CO activates RAAS system which then increases plasma vol and therefore increases venous return so cardiac performance deteriorates further
how does the heart weaken
As the heart starts to dilate the cardiac myocytes undergo hypertrophy and then fibrosis and thus the heart is further weakened
myocytes that become hypertrophic become ischaemic and die
The RAAS system causes the release of what?
angiotensin II – causes vasoconstriction
aldosterone
what does the Natriuretic peptide system ANP/BNP
cause salt watter loss
what does EDRF do?
muscle relaxation
vasodilation
treatment options to improve SYMPTOMS of heart failure? (2)
diuretics - no other drug that alters physical state of patient like them - gets rid of excess fluid so they don’t have peripheral oedema - also improves exercise capacity
digoxin - slows and controls heart rate
treatment options to improve SYMPTOMS AND SURVIVAL of heart failure? (3)
ACE inhibitors/ARBs
Spironolactone – mineralocorticoid - steroid hormone
Valsartan-sacubitril – expensive, inhibits the breakdown of natriuretic peptides resulting in varied effects including increased diuresis, natriuresis, and vasodilation.
