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2- SA- Cardiology > Management of heart failure > Flashcards

Management of heart failure Flashcards

1
Q

What is right sided heart failure commonly secondary to

A

pericardial effusion or right sided valve disease

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2
Q

List 4 things seen in a typical presentation of heart disease

A

cough/ dyspnoea
exercise intolerance
collapse
found by chance- e.g. murmur in vaccine consult
non specific weight loss

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3
Q

Which drugs help with contractility of heart

A

positive inotropes
e.g.
Pimobendan
Digoxin - not used much
Dobutamine - has to be given IV

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4
Q

Describe the effects of Pimobendan

A

calcium-sensitizing drug- positive inotrope- increases contractility
PDE3 inhibitor- vasodilation
has antithrombotic activity
also makes the animal feel better overall??

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5
Q

Describe the effects of Digoxin

A

positive inotropic agent - increases contractility
negative chronotropic agent- so also reduces heart rate
Has narrow therapeutic range
not used very much

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6
Q

What drugs should you give to hypertrophic/ restrictive cats

A

positive lusitropes- drugs that help heart relax
- calcium channel blockers–> diltiazem, verapamil
- beta-blocker –> propranolol, atenolol

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7
Q

T/F
In asymptomatic cats there is no evidence that any drug alters the natural history of HCM until they are in heart failure

A

True
Only treat cats when they are in congestive failure

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8
Q

Describe effects of Diltiazem

A

have positive lusitropic properties - help heart to relax
sometimes used as antidysrhythmic cases

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9
Q

Describe the standard CHF therapy in dogs

A

Diuretics- most important
Pimobendan
ACE inhibitor
Aldosterone antagonists

If owner can afford give all 4 of the drugs above

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10
Q

Describe stage B1 of heart disease

A

Asymptomatic patients with no radiographic or echocardiogenic evidence of cardiac remodelling

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11
Q

Describe how you would treat stage B1 of heart disease

A

No treatment but consider:
weight control
regular re-assessment
client education

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12
Q

What do diuretics do when treating heart disease

A

remove fluid- act at kidney to increase urine output
control oedema formation

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13
Q

Name 2 loop diuretics

A

Furosemide- most commonly used- very cheap
Torasemide- more expensive but only have to give once a day

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14
Q

List 2 potassium sparing diuretics, and why you could use these over loop diuretics

A

Spironolactone
Amiloride
Can combine with loop to reduce risk of hypokalaemia but not as good on own as diuretic

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15
Q

Describe frusemide

A

1st line diuretic
very potent
fast acting
when using can give high dose initially but need to reduce this as soon as possible
monitor for azotaemia and hypokalaemia

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16
Q

What do ACE inhibitors do, how do they work

A

Dilate arteries, veins or both
venous dilators- decrease pre-load –> reduce fluid build up
arterial dilators- reduce afterload –> increase output –> reduce valave leakage

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17
Q

What is Cardalis

A

a combination of ACE inhibitor (benazepril) and the aldosterone antagonist (spironolactone)
is used quite a lot in cats

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18
Q

Describe stage D of heart disease

A

obvious clinical signs with minimal exercise
progressively worsens
obvious clinical signs at rest
death
end-stage disease

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19
Q

describe stage C of heart disease/ failure

A

patients with past or current clinical signs of heart failure associated with structural heart disease.

20
Q

Describe what you would do in CHF emergency

A

furosemide IV
oxygen supplementation
cage rest
avoid stress
trying to get the animal stab;e

21
Q

List 2 management ideas for congestive heart failure patients

A

low salt diet- no real evidence - not always that palatable
exercise regime –> consistency is key, within capacity

22
Q

Describe the effects of Clopidogrel

A

inhibits platelet aggregation
no evidence based medicine

23
Q

What tends to come first in cats- pericardial effusion or RCHF

A

RCHF

24
Q

what comes first in dogs - pericardial effusion or RCHF

A

pericardial effusion

25
Q

List 3 main causes of heart failure

A

mitral valve disease
cardiomyopathy
other diseases causing HF

26
Q

what is a non-specific drug you can use to treat DCM

A

pimobendan - a positive inotrope

27
Q

how do positive inotropes help DCM

A

they help the heart deal with the increased preload

28
Q

how can digoxin help with heart disease

A

it inceases vagal tone and decreases sympathetic tone - this helps lead to vasodilation

29
Q

why must we be very careul with digoxin

A

it is toxic

30
Q

List the 3 goals of CHF treatment

A

control salt and water rentention
reduce workload of the heart
improve function of the heart

31
Q

Describe stage A heart failure

A

patients who are at high risk for developing heart failure but have no structural abnormalities

32
Q

Describe stage B2 heart failure

A

asymptomatic murmur patients with radiographic / echocardiographic evidence of heart enlargement

33
Q

Describe what you can do for stage B2 patients

A

Pimobendan
weight control
regular re-assessment
client education

34
Q

why is pimobendan given to stage B2 patients

A

it can help lengthen the time it takes for the patient to move into stage C

35
Q

Describe what can be done for stage C patients

A

begin PADS treatment:
Pimobendan
ACE inhibitors
Diuretics
Spironolactone

36
Q

List the 3 types of diuretics

A

loop
thiazide
potassium sparing

37
Q

Describe how loop diuretics work

A

Stops the reabsorption of sodium in the ascending loop of henle - this leads to more water being removed by the kidneys

38
Q

what is the first drug you start in a HF patient

A

furosemide - IV

39
Q

Describe spironolactone

A

aldosterone antagonist
potassium sparing diuretic

40
Q

how does spironolactone work

A

Spironolactone blocks aldosterone receptors in the late DCT and collecting duct

41
Q

what are the issues with giving a patient diuretics

A

you can cause hypovolaemia, you may exacerbate azotaemia, you stimulate the RAAS

42
Q

List 4 ACE inhibitors examples

A

benazepril
enalapril
ramipril
imadipril

43
Q

Describe how ACE inhibitors work

A

prevent the conversion of angiotensin I to angiotensin II which prevents vasoconstriction

44
Q

why do we have to be careful using pimobendan in cats with myocardial disease

A

we don’t want to improve the contractility too much in an already thickened heart

45
Q

why are thromboembolisms common in cats with HCM

A

because there is not a lot of room in the heart, the blood is regurgitated back and forth and this can lead to clot formation

46
Q

what can we do if CHF treatment is not working

A

increase doses, add other drugs (additional diuretics, antidysrhythmic agents, sildenafil for pulmonary hypertension)

2- SA- Cardiology (15 decks)

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