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Pharmocolgy > P15: Treatment of Heart Failure > Flashcards

P15: Treatment of Heart Failure Flashcards

1
Q

What is (congestive) heart failure

A

A state in which the heart cannot provide sufficient cardiac output to satisfy the metabolic needs of the body.

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2
Q

Name as many symptoms of Congestive Heart Failure as you can

A 
Shortness of breath upon motion
Coughing
Fluid retention
Oedema in lower limbs and abdomen
Increased nocturnal urination
Tiredness
Muscle Weakness
Dizziness
Irregular heartbeat 
May be asymptomatic
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3
Q

Define what happens in myocardial infarctions, coronary heart disease and cardiac arrest

A
  1. Myocardial Infarction - Death of a piece of heart tissue
  2. Coronary Heart Disease - failure of heart oxygen supply
  3. Cardiac Arrest - complete cessation of blood supply
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4
Q

AY BAWS CAN I HABE DE NOTE PLZ

A

Heat failure can cause similar symptoms to liver failure, kidney failure, obesity, thyroid disease and anaemia

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5
Q

What are the potential causes of heart failure

A

Any condition that reduces the efficiency of the myocardium through damage or overloading:
Myocardial infarction
Hypertension
Valve disease
Excessive Alcoholism
Infection
Amyloidosis - abnormal deposition of amyloid proteins in tissues

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6
Q

What can often be observed in the stroke volume and heart rate of people with heart failure

A

Reduced SV due to failure of systole and/or diastole

Increased HR due to increased SNS activity

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7
Q

What is the Frank Starling law of the heart

A

Stroke volume increases in response to an increase in the volume of blood filling the heart (EDV) when all other factors remain constant

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8
Q

What is the End Diastolic Volume

A

This is the amount of blood in the ventricle immediately before contraction

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9
Q

Describe the mechanism of the frank starling law

A

As a larger volume of blood flows into the ventricle, this stretches the walls of the heart, causing a greater expansion during diastole

This increases the force of the contraction and thus the quantity of blood that is pumped into the aorta during systole

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10
Q

Why does the mechanism of the frank starling law fail in congestive heart failure

A

Damage to cardiac muscle fibres

Ventricle wall overstretch, actin-myosin coupling becomes disorganised

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11
Q

The reduced CO from heart failure causes what physiological responses

A
  • Decreased arterial BP, activating baroreceptors and causing peripheral vasoconstriction - improves BP but increases heart workload
  • Increased pituitary ADH release, increased fluid retention, raises BP
  • Reduced kidney perfusion stimulates the RAAS system, promotes sodium and water retention, vasoconstriction
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12
Q

AY BAWS CAN I HABE DE NOTE PLZ

A

Loads of circulating hormones released in response to decreased CO directly induce structural remodelling of the heart, causing cardiac hypertrophy, like catecholamines, renin, angiotensin and aldosterone

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13
Q

What is Stroke volume governed by

A

Preload
Afterload
Contractility

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14
Q

What is preload

A

the EDV at the beginning of systole

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15
Q

What is afterload

A

ventricular pressure at the end of systole (i thot it was the resistnace that systole has to push against)

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16
Q

What are overall aims of heart failure treatment

A
  • Increase contractility of cardiac muscle
  • Reduced preload/afterload
  • Reduce water load (blood volume)
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17
Q

What are some examples of cardiac glycosides

A

Digoxin

Digitoxin

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18
Q

What is the mechanism and effect of cardiac glycosides

A
  • Bind to K+ site of Na+/K+ antiporter
  • Maintain Ca2+ entry
  • Increase contractile strength without increasing O2 demand

AY BAWS - improves symptoms, doesnt prevent mortality

19
Q

Name as many side effects of Digoxin (cardiac glycosides) as you can

A
  • Increased AV conduction time (increased vagal activity)
  • Increased incidence of ectopic pacemaker activity - increased autorhythmicity
  • Increased Diuresis
  • narrow therapeutic window
  • patients with hypokalaemia are at increased risk of toxicity
  • toxic effects of digoxin are managed by anti-digoxin antibodies
20
Q

What type of drugs are used to prevent/treat oedema

A

diuretics

21
Q

Where are oedemas most likely to happen

A

lungs and lower body

22
Q

Name a thiazide diuretic and describe its mechanism

A

Hydrochlorothiazide

Acts on early DCT = increased Na+ and K+ excretion

23
Q

Name a loop diuretic and describe its mechanism

A

Frusemide

Acts on ascending LOH = increased Na+ and K+ excretion

24
Q

Name a potassium sparing diuretic and describe its mechanism

A

spironolactone

Acts on the DCT = increased Na+ excretion, important when using cardiac glycosides

25
Q

What 2 approaches are used to reduce the preload/afterload

A
  1. Direct vasodilators
  2. Modulate the renin, angiotensin, aldosterone system

These reduce the arterial blood pressure and/or venous return

26
Q

AY BAWS CAN I HABE DE NOTE PLZ

A

i think the RAAS system, which occurs along with reduced arterial BP, causes Na+ and water retention, which can cause the oedema formation in ppl with heart failure lol?

27
Q

Name some ACE inhibitors

angiotensin converting enzyme

A

enalapril

captopril

28
Q

Name some angiotensin 2 receptor antagonists

A

iosartan

candesartan

29
Q

What are the overall effects of ATII

A

Increased ADH, aldosterone, SNS and vasoconstriction

30
Q

What converts angiotensinogen to angiotensin 1

A

renin

31
Q

why are the no useable renin inhibitors

A

too many side effects

32
Q

How do ACE inhibitors affect symptoms and mortality and ventricular hypertrophy

A
  • Improves symptoms
  • Decreases mortality
  • Reduces ventricular hypertrophy
33
Q

What can be used instead of ACE inhibitors

A

ATII receptor antagonists

34
Q

How do ACE inhibitors and ATII receptor antagonists decrease afterload

A

Antagonising the vasopressor effect of angiotensin, decreasing cardiac work

35
Q

What is a downside to ACE inhibitors

A

Produces a persistent cough

36
Q

What are ACE inhibitors often given alongside

A

Diuretics

37
Q

Name an organic nitrate and describe their general mechanism

A

Isosorbide Dinitrate

Intracellular NO activates guanylate cyclase, increasing cGMP
Causes increased Ca2+ sequestration and smooth muscle relaxation
Venodilator, reduces preload

38
Q

Name some problems with organic nitrates

A

Headaches
Flushing
Tachycardia
Tolerance

39
Q

Name some other vasodilators

A

Hydralazine (mechanism unclear)
Minoxidil (K+ channel opener)
Arterial vasodilators, reduce afterload

40
Q

When is isosorbide - hydralazine combo therapy used and why

A

Appears to be particularly beneficial in CHF patient of African or Caribbean origin

they respond less effectively to ACEI therapy

41
Q

What type of drugs aims to improve cardiac contractility in heart failure

A

Cardiac glycosides

42
Q

What type of drugs aim to reduce workload by reducing blood volume in heart failure

A

Diuretics

43
Q

What type of drugs aim to reduce workload by reducing pre/afterload

A

ACE inhibitors and vasodilators

Pharmocolgy (22 decks)

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