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

24
Q

what comes first in dogs - pericardial effusion or RCHF

A

pericardial effusion

25
List 3 main causes of heart failure
mitral valve disease cardiomyopathy other diseases causing HF
26
what is a non-specific drug you can use to treat DCM
pimobendan - a positive inotrope
27
how do positive inotropes help DCM
they help the heart deal with the increased preload
28
how can digoxin help with heart disease
it inceases vagal tone and decreases sympathetic tone - this helps lead to vasodilation
29
why must we be very careul with digoxin
it is toxic
30
List the 3 goals of CHF treatment
control salt and water rentention reduce workload of the heart improve function of the heart
31
Describe stage A heart failure
patients who are at high risk for developing heart failure but have no structural abnormalities
32
Describe stage B2 heart failure
asymptomatic murmur patients with radiographic / echocardiographic evidence of heart enlargement
33
Describe what you can do for stage B2 patients
Pimobendan weight control regular re-assessment client education
34
why is pimobendan given to stage B2 patients
it can help lengthen the time it takes for the patient to move into stage C
35
Describe what can be done for stage C patients
begin PADS treatment: Pimobendan ACE inhibitors Diuretics Spironolactone
36
List the 3 types of diuretics
loop thiazide potassium sparing
37
Describe how loop diuretics work
Stops the reabsorption of sodium in the ascending loop of henle - this leads to more water being removed by the kidneys
38
what is the first drug you start in a HF patient
furosemide - IV
39
Describe spironolactone
aldosterone antagonist potassium sparing diuretic
40
how does spironolactone work
Spironolactone blocks aldosterone receptors in the late DCT and collecting duct
41
what are the issues with giving a patient diuretics
you can cause hypovolaemia, you may exacerbate azotaemia, you stimulate the RAAS
42
List 4 ACE inhibitors examples
benazepril enalapril ramipril imadipril
43
Describe how ACE inhibitors work
prevent the conversion of angiotensin I to angiotensin II which prevents vasoconstriction
44
why do we have to be careful using pimobendan in cats with myocardial disease
we don't want to improve the contractility too much in an already thickened heart
45
why are thromboembolisms common in cats with HCM
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
what can we do if CHF treatment is not working
increase doses, add other drugs (additional diuretics, antidysrhythmic agents, sildenafil for pulmonary hypertension)