Management in heart failure - stage 1 + 2 Flashcards
Name 3 dietary restrictions that should be undertaken?
- Reduce salt intake 2. Reduce fluid intake (<1.5 l a day) 3. Reduce alcohol intake
Name 3 non pharmacological interventions?
- modify diet 2. Flu vaccine 3. Smoking cessation
Mx of NYHA class 1?
- Ace inihibitor 2. Diuretic
First line mx - ( NYHA class 2 )
- Ace inhibitor 2. Beta blocker 3. Diuretic
Mechanism of action of ace inhibitors?
- Potent vasodilators 2. Reduce after load and fluid retention therefore slowing down left ventricular disease progression
When are ace inhibitors prescribed?
Recommended for all patients with heart failure
When are ace inhibitors contraindicated?
- renal artery stenosis 2. previous angioedema 3. Pregnancy
Name 4 side effects to ace inhibitors?
- Low BP 2. Hyperkalaemia 3. Dry cough 4. Renal failure 5. Hypoglycaemia
Name 2 ace inhibitors?
- Ramipril 2. Lisinopril
When are ARBs prescribed?
When the patient develops side effects such as a dry cough or is contraindicated to ACE inhibitors. -Candasartan/Losartan
What is the third line option is patient is intolerant to ACEinbitors and ARBs?
Hydralazine + Nitrates
What should Ace inhibitors not be used alongside with and what is the risk?
- Potassium sparing diuretic - Spirnolactone 2. Can cause hyperkalaemia
What is the impact of Ace inhibitors on a patient with Heart failure?
Improves prognosis in all stages of HF
What should be monitored after prescribing ACE inhibitors / ARBs
- Creatinine 2. U and Es 3. eGFR
What is the role of Entresto - Sacubritil/Valsartan in HF?
- Used in the place of ace inhibitors and angiotensin receptor blockers
What is the mechanism of action of ERNESTO - Sacubutril/Valsartan
- Blocks Neprilysin enzyme which is responsible for breaking down acute phase proteins and naturetic peptides
- increase in ANP/BNP/Bradykinin etc
- . RESULTS -
- decreases sympathetic tone
- vasodilation
- lowers blood pressure
What is the impact of Beta blockers in a patient with HF?
- 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%
mechanism of action of Beta blockers in a patient with HF?
Reduces after load and heart rate to prevent arrythmias
Name 3 side effects of beta blocker use?
- Postural hypotension 2. Bradycardia
Name 3 contraindications of beta blocker use?
- Asthma 2. 2nd/3rd degree AV block
What is the role of Ivabradine in Heart failure?
used if heart rate is > 75 on beta blockers and still have symptoms
When are diuretics used in heart failure?
- 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.
What is the impact of diuretic use in patients with heart failure?
- Provides symptomatic relief by preventing fluid overload 2. Does not improve prognosis
What should be monitored when prescribing diuretics?
- monitor weight 2. monitor U +Es
What is the first line diuretic for heart failure?
Loop diuretic - furosemide
Name 2 side effects of prescribing a loop diuretic?
- electrolyte imbalance 2. gout
What are the two second line diuretics for heart failure?
- Thiazide diuretics 2. Potassium sparing diuretics / Mineral receptor corticoids e.g. Spirnolactone
What is the mechanism of action of ‘Ivabradine’?
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
