Treatment of Heart Failure

Question 1

What happens to CO in a heart failure patient if preload is increased?

Answer 1

Decreases

Question 2

What 4 physiological parameters of heart failure need to be targeted in treatment and how do they need to be altered?

Answer 2

Increase CONTRACTILITY
Decrease PRELOAD and/or AFTERLOAD –> decrease CARDIAC WORKLOAD
- by relaxing vascular smooth muscle
- by reducing blood volume
Inhibit Renin Angiotensin Aldosterone System (RAAS)
Prevent inappropriate increase in HR

Question 3

What is the recommended treatment plan (drugs in order) for heart failure?

Answer 3

DAB!
D: Diuretic
A: ACE inhibitor or ARB
B: Beta blocker

Question 4

List as many signs and symptoms of heart failure as possible.

Answer 4

o	Shortness of breath
o	Swelling of feet and legs
o	Chronic lack of energy
o	Difficulty sleeping due to breathing problems
o	Swollen or tender abdomen with loss of appetite
o	Cough with frothy sputum
o	Increased urination at night
o	Confusion and/or impaired memory

Question 5

What are some conditions that often predispose to heart failure?

Answer 5

CHD (via atherosclerosis of coronary arteries)
Hypertension
Cardiomyopathy
AF
Anaemia
Overactive thyroid gland (since thyroxin’s MOA is similar to adrenaline’s MOA)

Question 6

Why are ACE inhibitors, beta blockers, aldosterone antagonists and ARBs appropriate for the treatment of chronic heart failure?

Answer 6

Promote production of angiotensin II and release of ADH

Question 7

Is heart failure cured by these drugs?

Answer 7

No, these pharmaceutical agents can alleviate symptoms and prolong life, but don’t treat the underlying cause

Question 8

What is the MOA of diuretics in heart failure treatment?

Answer 8

Mobilise oedematous fluid

Question 9

What are the 5 main classes of drug used in treatment of heart failure?

Answer 9

Loop diuretics
ACE inhibitors
ARBs
Aldosterone receptor antagonists
Beta blockers

Question 10

What class of drug does candesartan belong to?

Answer 10

ARBs

Question 11

What does ARB stand for?

Answer 11

Angiotensin II Receptor Blocker

Question 12

Give two examples of beta blockers used in heart failure treatment.

Answer 12

Carvedilol

Bisoprolol

Question 13

What is the primary example of an aldosterone receptor antagonist?

Answer 13

Spironolactone

Question 14

What class of drug does ramipril belong to?

Answer 14

ACE inhibitors

Question 15

Give two examples of ACE inhibitors.

Answer 15

Ramipril

Lisinopril

Question 16

What class of drug does furosemide belong to?

Answer 16

Loop diuretics

Question 17

What is an advantage of candesartan?

Answer 17

Doesn’t increase risk of mortality

Question 18

Why is carvedilol a special type of beta blocker?

Answer 18

Because it blocks both beta receptors and alpha receptors

Question 19

Where in the nephron do loop diuretics act?

Answer 19

Thick ascending limb of Loop of Henley

Question 20

How do loop diuretics increase urine output?

Answer 20

Loop diuretics inhibit the passage of K+, Cl- and Na+ from the collecting tubule back into the renal circulation, meaning water can’t pass back into the capillaries either (water follows solute (ions))

Question 21

Where in the nephron does spironolactone act?

Answer 21

Collecting duct

Question 22

How can beta blockers have a negative effect on CO and what is this effect?

Answer 22

Decrease HR, decreasing CO

Question 23

What positive effects do beta blockers have on the CVS?

Answer 23

Allow increased, more complete ventricular filling during diastole
Some may cause vasodilation –> decreased afterload

Question 24

What are some common side effects of RAAS inhibitors?

Answer 24

ACE inhibitors:
- persistent dry cough
- headaches
- dizziness
- tiredness
ARBs:
- dizziness
- headaches
- back/leg pain

Question 25

What are some common side effects of aldosterone receptor antagonists?

Answer 25

Hyperkalaemia
Hyponatraemia
Nausea
Hypotension

Question 26

What are some common side effects of loop diuretics?

Answer 26

Acute gout (common with high doses)