Non Pharm Management Cardiac Failure

Question 1

Which phase do we try to keep HF in?

Answer 1

Compensated

Question 2

What do HF drugs try to do?

Answer 2

Attentuate neurohormones enough to keep CO up without over-working heart (ANP/BNP, noradrenaline, vasopressin, endothelin, aldosterone, angiotensin II)

Question 3

What is LCZ 696 and how does it work?

Answer 3

• Dual neurohormonal inhibition
  1. Sacubitral part = inhibits Neprolysin
  2. Valsartan part = angiotensin II blocker
• So blocks angiotensin blocker + increases naturetic peptides

Question 4

What are the iron deficiency mechanisms in HF?

Answer 4

• Absolute Fe deficiency - malnutrition, malabsorption…
• Anaemia of chronic disease = inflammation
• EPO deficiency
• Haemodilution

Treat anaemia! Improves prognosis

Question 5

How is sleep apnoea diagnosed?

Answer 5

• Nasal canulas - air flow
• Bands across chest - abdominal/thoracic movements
• O2 saturation

Apnoea = complete cessation of airflow > 10 sec

Question 6

What is obstructive sleep apnoea?

Answer 6

• Collapse of pharyngeal airway
• Thoraco-abdominal movements present
• CPAP

Question 7

What is central sleep apnoea?

Answer 7

• No thoraco-abdominal movements

- Nocturnal ventilation makes HF worse so no CPAP

Question 8

How is mitral regurgitation treated?

Answer 8

Catheter through femoral vein > hole in atrial septum + clip together leaflets of mitral valve

Question 9

What is a biventricular defibrillator?

Answer 9

Pacemaker + defibrillator

Question 10

How can cardiac devices be used in remote monitoring?

Answer 10

• Can measure impedance = fluid in lung from congestion

- If low, alert sent - call patient + tell them to take tablets