Heart Failure Treatment Flashcards
Chronic Heart Failure is a syndrome characterized by (5)
- Progressive cardiac dysfunction
- Breathlessness
- Tiredness
- Neurohormonal disturbances
- Sudden death
CHF is a 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
Types of Heart Failure (2)
Systolic
Diastolic
Systolic heart failure
Decreased pumping function of the heart which results in fluid back up in the lungs and heart failure
Diastolic Heart Failure
Involves a thickened or stuff heart muscle.Heart does not fill with blood properly and results in fluid backup in the lungs and heart failure
Risk Factors for Heart failure (7)
- Coronary artery disease
- Hypertension- no.1 link
- Valvular heart disease
- Alcoholism
- Infection (viral)
- Diabetes
- Congenital heart defects
Number 1 link to heart failure
Hypertension
Other factors that increase the risk of heart failure (5)
Obesity Age Smoking High or low haematocrit level Obstructive sleep apnoea
What is the pathological progression of CV Disease
Diseases leads to myocardial injury
Myocardial injury triggers neurohormonal stimulation and myocardial toxicity and pathological remodelling
Low ejection fraction produced symptoms such as dyspnoea, fatigue and oedema
Leads to death if not treated
Frank-Starling Law
if the muscle of a healthy heart is stretched it will contract with greater force and pump out more blood
How is the Frank-Starling Law lost in a damaged heart (2)
- As circulatory volume increases the heart dilates, the force of contraction weakens and cardiac output drops further
- Decrease in CO activates the RAAS further
As the damaged heart starts to dilate what happens to the myocytes
They undergo hypertrophy and then fibrosis and thus the heart is further weakened
Salt and water excretion and vasodilation and controlled by (3)
- Natriuretic peptide system ANP/BNP
- EDRF
- Atrial and Brain Natriuretic peptides
What are the 2 aimes of usual treatment
Improve symptoms and survival
What improves symptoms (2)
Diuretics
Digoxin
What improves symptoms and survival (3)
ACEI/ARB
Spironolactone
Valsartan-sacubitril
What treatment improves survival (2)
Beta blockers
Ivabradine
Symptomatic Treatment (3)
- Inhibition of detrimental neurohormonal adaptions
- Enhancement of beneficial neurohormonal adaptions
- Enhancement of cardiac function
Symptomatic treatment examples
Loop diuretics
Examples of loop diuretics
Furosemide or Bumetanide
Action of Furosemide (4)
Remove excess salt and water
Induce diuresis
Inhibit the Na-K-cl transporter in the loop of henle
Works at a low GFR
If someone is resistant to diuretics what do you give them
Thiazide diuretics
Adverse drug reaction of thiazide (6)
Dehydration Hypotension Hyperkalaemia Hyponatraemia Impaired glucose tolerance Diabetes
Blocking sympathetic action (4)
Carvedilol
Bisoprolol
Metroprolol
Beta blockers
Blocking RAAS activation
ACEI (Ramipril) Angiotensin antagonist (Valsartan, Losartan)
Blocking effects of aldosterone
Spironolactone
Enhancing Beneficial Hormonal Change
Neprolysin
Action of Neprolysin (2)
Prevents metabolism
Enhances ANP/BNP actions
Atrial natriuretic and Brain Natriuretic peptides action (2)
Potent natriuretic agents and vasodilators
Enhancement of cardiac function (2)
Digoxin
Vasodilators
Action of Digoxin
Improves the ability of the heart to pump and so improves cardiac status
Action of Vasodilator
Hydralazine
Reduces preload and afterload to improve cardiac function (Isosorbide, mono or dinitrate)
Furosemide + Aminoglycosides
Aural and renal toxicity
Furosemide + Lithium
Renal toxicity
Furosemide + NSAIDs
Renal toxicity
Furosemide + Antihypertensives
Profound hypotension
Furosemide + Vancomycin
Renal toxicity
ACEI examples
Ramipril, Enalpril, Lisonopril
Action od ACEI (3)
- Completely block angiotensin converting enzyme
- Prevent the conversion of angiotensin I to II
- Reduce preload and afterload on the heart
Main studies of ACEI (5)
CONCENSUS, SOLVD, SAVE, AIRE, ISSIS-4
Adverse Drug reactions (6)
- First dose hypotension
- Cough
- Angioedema
- Renal impairment
- Renal failure
- Hyperkalaemia
ACEI + NSAID
Acute renal failure
ACEI + Potassium supplements
Hyperkalaemia
ACEI + Potassium sparing diuretucs
Hyperkalaemia
When are Angiotensin Receptor Blockers used
When the patient is intolerant to AcEI
Action of ARB
Block the angiotensin II AT1 receptor
Major outcome studies involving ARB (3)
Elite II, Charm, ValHeft Valiant
AT1 receptor is responsible for the activation of (5)
Vasoconstriction Vascular proliferation Aldosterone secretion Cardiac myocyte proliferation Increased sympathetic tone
AT2 receptor is responsible for the activation of (3)
Vasodilation
Antiproliferation
Apoptosis
Valsartan and Sacubitril are
Angiotensin Receptor Neprilysin Inhibitors
Action is ARNI
stops the breakdown of ANP and BNP by neutral endopeptidases
Aldosterone antagonist
Spironolactone
Action of Spironolactone
Potassium sparing diuretic
Inhibits the actions of aldosterone
Where does Spironolactone act on
Distal Tube
What can Aldosterone antagonists be used with (2)
Loop diuretics
ACEI
Study associated with Aldosterone antagonists and ACEI
RALES
Beta Blockers
Carvedilol
Bisprolol
Metroprolol
Action of Beta blockers (4)
- Potentially hazardous method of treating CHF
- Block the actions of the sympathetic system
- My precipitate severe deterioration
- Should be used only when a patient has been stabilised and not during an acute presentation
Ivabradine mode of action (3)
- Ivabradine is a specific inhibitor of the of current in the SA node
- No action on other channels in the heart or vascular system
- Does not modify myocardial contractility and intracardiac conduction, even in patients with impaired systolic function
What kind of patients would Ivabradine be useful in? (3)
Symptomatic stable chronic HF
Receiving standard therapy including beta blocker
Have HR greater than 70 bpm at rest
Positive inotropes
Digoxin
Action of Digoxin
Increases availability of calcium in the myocyte
Side effects of Digoxin (4)
Narrow therapeutic index
Arrhythmias
Nausea
Confusion
Anticoagulants
Warfarin
What leads to thrombus formation and thromboembolic events
Dilated ventricle
