Heart Failure treatment

Question 1

strategies for HF treatment

Answer 1

increase cardiac contractility 
decrease preload/afterload to dec work (relax SM, reduce blood volume) 
inhibit RAAS
decrease HR 
mobilise oedematous fluids

Question 2

non pharma management of HF

Answer 2

lifestyle 
device therapy (pace, CRT, ICD, revascularisation, transplant)

Question 3

Acronym for HF

Answer 3

ABBA 
ACE/ARB
Beta block 
aldosterone antagonist 
\+ diuretics

Question 4

which diuretics do you use first in HF

Answer 4

loop (act on thick ascending limb Na/Cl)

- furosemide, bumetanide

Question 5

where do thiazide diuretics act

Answer 5

on distal tubule Na/Cl transporter

Question 6

side effects of loops

Answer 6

electrolyte disturbance (low K, Na, Mg, Ca) 
hypotension,
renal impairment 
hypovolaemia 
nocturia if taken too late in day 
acute gout

Question 7

effects of using ACEI/ARBs

Answer 7

reduce salt and water retention 
reduce vasoconstriction 
reduce vascular resistance
reduce afterload
improve tissue perfusion 
reduces ventricular remodelling/hypertrophy

Question 8

side effects of ACEI/ARBs

Answer 8

dizzy
headache 
hyperkalaemia 
renal impair 
NOT RENAL STENPSIS OR PREGNANCY

Question 9

side effects of ACEI

Answer 9

dry cough
tiredness
angiooedema

Question 10

side effects of ARBs

Answer 10

back/leg pain

Question 11

why use beta blockers in HF

Answer 11

aloows ventricle to fill more completely during diastole
(some cause vasodilation via alpha R blocking - dec afterload - carvediol)
also reduces renin release

Question 12

which beta blockers use in HF and when

Answer 12

carvedilol, bisoprolol 
if reduced EF but stable NYHA class 2-4

Question 13

beta blocker drug interactions

Answer 13

risk of bradycardia/AV block with digoxin, amiodarone, verapamil, diltiazem

Question 14

beta blocker side effects

Answer 14

bradycardia
fatigue
SOB
dizzy, cold peripheries, impotence, insomnia

Question 15

Aldosterone R antagonists side effects

Answer 15

hyperkalaemia 
hyponatraemia 
hypotension 
gynaecomastia 
renal impairment

Question 16

step 3/4

Answer 16

sacubitril + valsartan

ivabradine

Question 17

digoxin mechanism of action

Answer 17

increases force of myocardial contraction
- inhibits Na/K/ATPase pump –> affects Na/Ca exchanger -> inc intracellular Ca levels in SR –> when Ca released there’s lots

Question 18

treatment of acute decompensated heart failure first line

Answer 18

LMNOP
L- IV loop 
M- iv morphine 
N - Iv nitrates 
O - maintain O2 sats 
P - position upright

Question 19

second line acute decompensated HF treatment

Answer 19

ionotropic agents

• beta agonists (dobutamine, dopamine, isoprenaline, adrenaline)
• vasopressors (NA)