Heart Failure - Treatment Flashcards
Learning Outcomes
What is heart Failure Characterised by?
–by progressive cardiac dysfunction
–breathlessness
–tiredness
–neurohormonal disturbances
–sudden death
What is congestive heart failure defined as?
Heart unable to pump blood that meets the demands of the tissues or it can do so but only from high pressures.
What are the two types of heart failure?
Systolic heart failure - Decreased pumping function of the heart, which results in fluid back up in the lungs and heart failure
Diatolic heart failure
(HFrEF - heart failure with presereved ejection fraction)
Diastolic Heart Failure - Thickened and stiff heart muscle
- Heart does not fill properly with blood
- Fluid back up in the lungs and hear failure
(HFpEF) - Heart failure with preserved ejection fraction
Risk factors for heart failure
- Coronary artery disease
- Hypertension (LVH)
- Valvular heart disease
- Alcoholism
- Infection (viral)
- Diabetes
- Congenital heart defects
- Other:
–Obesity
–Age
–Smoking
–High or low hematocrit level
–Obstructive Sleep Apnea
What is the effect of heart failure on Frank - Starling Law?
Failing heart causes the relationship to be lost - amount of stretch is no longer proportional to the force of contraction
Circulatory volume increases - heart dilates - force of contraction reduces and there is a further drop in cardiac output.
Activation of the RAAS (renin angiotensin aldosterone system)
When does heart failure usually occur?
Following sustained hypertension
As a result of myocyte damage - MI
What is the result of a reduced cardiac output on blood pressure?
What is the effect of –Atrial and Brain Natriuretic Peptides?
- Potent vasodilators and natriuretic peptides
- Short halflife
What are the drugs for the treatment of symptoms?
- Diuretics
- Digoxin
What is the treatment for the improvement of symptoms and survival?
- ACE inhibitors/ARBs
- Spironolactone
- Valsartan-sacubitril
What are the goals of treatment?
- Symptomatic treatment
- Inhibition of detrimental neurohormonal adaptations
- Enhancement of beneficial neurohormonal adaptations
- Enhancement of cardiac function
Give examples of loop diuretics
–FUROSEMIDE or BUMETANIDE
How is sympathetic activation blocked?
Beta blockers - in this case:
–CARVEDILOL, BISOPROLOL and METOPROLOL are beta blockers which are of proven benefit in the treatment of CHF
What are the two types of drugs that block the effects of angiotensin 2?
Ace inhibitors (Rampril)
Angiotensin antagonists
How is aldosterone blocked?
Spironolactone - Produces a significant reduction in morbidity
What are the beneficial hormonal changes that we want to enhance?
Natriuretic peptide system
What metabolises brain and heart natriuretic peptides?
Neutral endopeptidse
What is the effect of digoxin?
Enhances cardiac function - improves cardiac statue
Digoxin toxicity is a very likely
What is the effect of vasodilators?
Reduce preload and afterload - improving cardiac function
–Hydralazine an arterial dilator has also been shown to improve cardiac function
Give examples of vasodilators
ISOSORBIDE MONO or DINITRATE
How do loop diuretics work?
Inhibit the sodium potassum chlorine transporter in the loop of henle- inducing profound diuresis.
What are the adverse drug reactions for diuretics?
–Dehydration
–Hypotension
–Hypokalaemia, Hyponatraemia
–Gout
–Impaired glucose tolerance, diabetes
What are the drug drug interactions wih frusemide?
