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CDL301 > Lecture 05 LV Dysfunction and HF 1 > Flashcards

Lecture 05 LV Dysfunction and HF 1 Flashcards

1. Describe the patterns of clinical presentation of LV dysfunction, chronic heart failure and acute heart failure 2. Describe neurohumoral activation in heart failure, with an understanding of the interaction between the renin-angiotensin-aldosterone and sympathetic nervous systems 3. Describe pharmacological interventions in chronic heart failure, with an emphasis on neurohumoral blockage rather than direct stimulation of cardiac contraction in patients with chronic heart failure 4. Understa

1
Q

Define: Heart Failure

A

heart failure is a complex clinical syndrome of symptoms and signs that suggest the efficiency of the heart as a pump is impaired, despite normal filling pressures

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2
Q

How many prevalent cases of heart failure are there in the UK?

A

~ 1 million

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3
Q

Describe the epidemiology of heart failure

A

cases of heart failure predicted to increase by 50% over the next 25 years
by 2032 23% of the UK population will be aged over 65 and over 3 million aged over 85

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4
Q

Why is research for heart failure treatment so important?

A

makes 5% all emergency admissions
high cost of treating, mostly due to hospitalisation
currently poor prognosis leading to greater than 30% mortality in the first year and increasing 10% per year after that

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5
Q

A prognosis of heart failure is similar to what cancers?

A

prostate and colorectal

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6
Q

What is an example of chronic heart failure?

A

left ventricular systolic dysfunction (LVSD)

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7
Q

What is an example of acute heart failure?

A

heart failure with preserved ejection fraction (HFPEF)

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8
Q

What type of heart failure is HFPEF?

A

diastolic

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9
Q

What causes heart failure?

A

structural or functional abnormalities of the heart

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10
Q

What are the most common risk factors?

A

smoking, drinking and diabetes (fat build up)

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11
Q

What therapy has been the most/least promising for LVSD?

A

vasodilator therapy via neurohumoral blockade

not direct LV stimulants

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12
Q

Does LVSD also mean heart failure?

A

no, but it will if there are problems with diastole or the valves

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13
Q

What are the symptoms of LVSD?

A

reduced cardiac output

increased filling pressures (backwards pressure)

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14
Q

What do these symptoms present as?

A

fatigue and exercise intolerance
pulmonary oedema (breathlessness)
congested and prominent jugular veins
ankle oedema

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15
Q

What drug can be used to treat heart failure and hypertension?

A

diuretics

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16
Q

What are the four classes of diuretics?

A

thiazides
loop diuretics
potassium-sparing diuretics
aldosterone antagonists

17
Q

Give examples of thiazides (x3)

A

bendroflumethiazide
hydrochorothiazide
chlorothalidone

18
Q

What do Thiazides act on?

A

act on distal tubule to treat hypertension

19
Q

Give examples of Loop Diuretics (x2)

A

furosemide

bumetanide

20
Q

What do Loop Diuretics act on?

A

loop of Henle

key for treating heart failure

21
Q

Give examples of Potassium-sparing Diuretics (x4)

A

spironolactone
eplerenone
amiloride
triamterene

22
Q

What is a side effect of Spironolactone? What should you do if this occurs?

A

has an effect on oestrogen and progesterone causing breast tissue sensitivity in males and females
if occurs switch patient to eplerenone

23
Q

What does spironolactone and eplerenone act on?

A

encourage sodium loss through the angiotensin system

24
Q

What is the advantage of Spironolactone over more traditional Potassium-sparing Diuretics?

A

cheap
very effective
huge impact on patient survival

25
Q

What are the more traditional Potassium-sparing Diuretics?

A

amiloride

triamterene

26
Q

How do Aldosterone Antagonists work?

A

block the aldosterone pathway

27
Q

What are the main adverse effects of Diuretics?

A 
hypovolaemia 
hypotension
hypokalaemia
hyponatraemia
hypomagnesaemia
hypocalcaemia
hyperuricaemia and gout
28
Q

What are the adverse effects of Thiazides?

A

erectile dysfunction

diabetes

29
Q

Give an example of vasodilator therapy. How does it work?

A

hydralazine and isosorbide dinitrate
hydralazine is an arterial dilator
isosorbide dinitrate is a venous dilator buffering blood supply and decreasing venous return

30
Q

In terms of personalised medicine, what must be taken into consideration when treating with hydralazine and isosorbide dinitrate?

A

ethnicity

genetic differences mean this treatment has greater impact on Afro-American’s aldosterone pathway

31
Q

What was the result of the vasodilator therapy study on mortality?

A

significant reduction in mortality by 36%

32
Q

Is Prazosin a good vasodilator for LVSD? Why?

A

no, little difference between placebo and prazosin treatment in terms of mortality

CDL301 (14 decks)

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