Management of heart failure - stage 2 +

Question 1

What is the 3rd line management of HF?

Answer 1

1. Ace inhibitors/ ARB and 2. Beta blocker and 3. Aldosterone antagonist

Question 2

Name two side effects of potassium sparing diuretics?

Answer 2

1. Gynaocomastia 2. Renal dysfunction 3. Hyperkalaemia

Question 3

What is the 4th line management of HF?

Answer 3

ACE inhibitors or ARB - ADD diuretic - ADD beta-blocker - ADD aldosterone antagonist - ADD digoxin

Question 4

What is the role of Digoxin in HF?

Answer 4

1. Sinus rhythm patients that remain symptomatic despite other interventions 2. Used to treat AF in heart failure

Question 5

What should be given in a patient with HF with an arrythmia?

Answer 5

Amiodorone

Question 6

What is the mechanism of action of Digoxin?

Answer 6

1. cardiac myocytes increase uptake of calcium to increase power and contractility of the muscle
2. eliminate K+ from cardiac myocytes to increase time for repolarisation thus slow down the heart rate
3. • inc stroke vol + reduces work of heart

Question 7

Name 2 symptoms of Digoxin toxicity?

Answer 7

1. Colour blindness
2. Tachycardia

antidote - digibind

Question 8

Name 3 surgical interventions in Heart failure?

Answer 8

1. Valvular replacement
2. Implanted Automatic cardiodefibrillator or pacemaker
3. Heart transplant may be considered in the end stages

Question 9

Name two implantable devices in Heart failure?

Answer 9

1. Left ventricular assist device
2. ICD - cardiac defibrillator recommended in patients with ejection fraction of <35 %

Question 10

Name 5 adjunct to heart failure?

Answer 10

1. Opiods - peripheral vasodilation and pain relief

2. Statin - reduces cholesterol
3. Asprin - inhibits thromboxane and reduces tendency to clot
4. Warfarin - patients who have AF
5. Amlodapine - calcium channel blocker to reduce blood pressure if still high