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*Cardiovascular - Heart failure > Management in heart failure - stage 1 + 2 > Flashcards

Management in heart failure - stage 1 + 2 Flashcards

1
Q

Name 3 dietary restrictions that should be undertaken?

A
  1. Reduce salt intake 2. Reduce fluid intake (<1.5 l a day) 3. Reduce alcohol intake
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2
Q

Name 3 non pharmacological interventions?

A
  1. modify diet 2. Flu vaccine 3. Smoking cessation
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3
Q

Mx of NYHA class 1?

A
  1. Ace inihibitor 2. Diuretic
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4
Q

First line mx - ( NYHA class 2 )

A
  1. Ace inhibitor 2. Beta blocker 3. Diuretic
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5
Q

Mechanism of action of ace inhibitors?

A
  1. Potent vasodilators 2. Reduce after load and fluid retention therefore slowing down left ventricular disease progression
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6
Q

When are ace inhibitors prescribed?

A

Recommended for all patients with heart failure

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7
Q

When are ace inhibitors contraindicated?

A
  1. renal artery stenosis 2. previous angioedema 3. Pregnancy
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8
Q

Name 4 side effects to ace inhibitors?

A
  1. Low BP 2. Hyperkalaemia 3. Dry cough 4. Renal failure 5. Hypoglycaemia
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9
Q

Name 2 ace inhibitors?

A
  1. Ramipril 2. Lisinopril
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10
Q

When are ARBs prescribed?

A

When the patient develops side effects such as a dry cough or is contraindicated to ACE inhibitors. -Candasartan/Losartan

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11
Q

What is the third line option is patient is intolerant to ACEinbitors and ARBs?

A

Hydralazine + Nitrates

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12
Q

What should Ace inhibitors not be used alongside with and what is the risk?

A
  1. Potassium sparing diuretic - Spirnolactone 2. Can cause hyperkalaemia
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13
Q

What is the impact of Ace inhibitors on a patient with Heart failure?

A

Improves prognosis in all stages of HF

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14
Q

What should be monitored after prescribing ACE inhibitors / ARBs

A
  1. Creatinine 2. U and Es 3. eGFR
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15
Q

What is the role of Entresto - Sacubritil/Valsartan in HF?

A
  1. Used in the place of ace inhibitors and angiotensin receptor blockers
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16
Q

What is the mechanism of action of ERNESTO - Sacubutril/Valsartan

A
  1. Blocks Neprilysin enzyme which is responsible for breaking down acute phase proteins and naturetic peptides

  1. increase in ANP/BNP/Bradykinin etc
  2. . RESULTS -
    - decreases sympathetic tone
    - vasodilation
    - lowers blood pressure
17
Q

What is the impact of Beta blockers in a patient with HF?

A
  1. Used in combination with Ace inhibitors 2. Improves survival in patients with mild to moderate heart failure 3. should be used in all pt with LVEF <40%
18
Q

mechanism of action of Beta blockers in a patient with HF?

A

Reduces after load and heart rate to prevent arrythmias

19
Q

Name 3 side effects of beta blocker use?

A
  1. Postural hypotension 2. Bradycardia
20
Q

Name 3 contraindications of beta blocker use?

A
  1. Asthma 2. 2nd/3rd degree AV block
21
Q

What is the role of Ivabradine in Heart failure?

A

used if heart rate is > 75 on beta blockers and still have symptoms

22
Q

When are diuretics used in heart failure?

A
  1. NYHA Class 1 of heart failure to help control fluid overload 2. Stop diuretics once fluid overload is fixed and continue with managing diet and fluid intake.
23
Q

What is the impact of diuretic use in patients with heart failure?

A
  1. Provides symptomatic relief by preventing fluid overload 2. Does not improve prognosis
24
Q

What should be monitored when prescribing diuretics?

A
  1. monitor weight 2. monitor U +Es
25
Q

What is the first line diuretic for heart failure?

A

Loop diuretic - furosemide

26
Q

Name 2 side effects of prescribing a loop diuretic?

A
  1. electrolyte imbalance 2. gout
27
Q

What are the two second line diuretics for heart failure?

A
  1. Thiazide diuretics 2. Potassium sparing diuretics / Mineral receptor corticoids e.g. Spirnolactone
28
Q

What is the mechanism of action of ‘Ivabradine’?

A

Inhibits ‘f’ funny channels in the heart and reduces the amount of potassium entering the cell

  • slows down repolarisation
  • heart rate reduction

Reduces symptoms but does not reduce mortality

*Cardiovascular - Heart failure (3 decks)

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