Therapy for chronic heart failure Flashcards
What is systolic heart failure?
Caused by decreased pumping ability of the heart, resulting in fluid back up into the lungs and heart failure
What is diastolic heart failure?
Involves a thickened and stiff cardiac muscle, which prevents the heart filling up with blood properly, leading to back up of fluid into the lungs and cardiac failure
List some risk factors for heart failure
CAD Hypertension and left ventricular hypertrophy Valvular disease Alcoholism Infection DM CHD Obesity Age Smoking High or low haematocrit levels Obstructive sleep apnea
What law explains the decreased effectiveness of heart pumping due to a stiffening of the cardiac muscle?
Frank-Starling law - if muscle is stretched it will contract with greater force and pump out more blood
What type of HF is most associated with MI?
Systolic HF
What type of HF is most associated with hypertension?
Diastolic HF
How do loop diuretics work?
Inhibit Na-K-Cl transporter in loop of Henle, increasing excretion of Na and water
Name some loop diuretics
Furosemide
Bumetonide
Name some ACEIs
Ramipril
Name some ARBs
Valsartan
Losartan
Describe some ADRs of loop diuretics
Dehydration Hypotension Hypokalaemia Hyponatraemia Gout Impaired glucose tolerance (important in diabetes)
Name some DDIs with loop diuretics
Aminoglycosides (toxicity) Lithium (toxicity) NSAIDs (renal toxicity) Antihypertensives (profound hypotension) Vancomycin (renal toxicity)
Why does some angiotensin I still get converted to angiotensin II in the body despite use of ACEIs?
There are alternative enzymes for the reaction in the body e.g. chymase
What enzymes can catalyse angiotensin I to angiotensin II?
Angiotensin converting enzyme
Chymase
What are some ADRs associated with ACEIs?
First dose hypotension Cough Angioedema Renal impairment Renal failure Hyperkalaemia
