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Flashcards in heart failure treatment Deck (31)
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1
Q

what are the characteristics of chronic heart failure?

A
  • progressive cardiac dysfunction
  • dyspnoea
  • tiredness
  • neurohormonal disturbances
  • sudden death
2
Q

what is systolic heart failure (HFrEF)?

A

heart fialure reduced ejection fraction.Decreased pumping function of the heart, which results in fluid back up in the lungs and heart failure

3
Q

describe the pathophysiology of diastolic heart failure (HFpEF)?

A
  • a thickened and stiff heart muscle
  • heart does not fill with blood properly as compliance decreases
  • this results in fluid backup in the lungs and heart failure
4
Q

what are the risk factors for heart failure?

A
coronary artery disease
hypertension
valvular heart disease
alcoholism
infection (viral)
diabetes
congenital herat defects
obesity 
age
smoking
obstructive sleep apnoea
high or low haematocrit
5
Q

describe the pathophysiology of systolic dysfunction heart failure?

A
  • failing or damaged heart causes it to not follow Starling’s law
  • so cardiac outpt decreases
  • this activates RAAS and synathetis system and circulatory volume increases and vasoconstriction
  • this causes further dilation of the heart so CO drops further as the myocytes hypertrophy and then fibrose
  • RAAS activarted again and so on.
6
Q

what are the treatments just for the symptoms of heart failure?

A

diuretics

digoxin

7
Q

what are the treatments for heart failure that both treat symptoms and increase survival?

A

ACEi/ARBs
spironolactone
valsartan-sacubitril

8
Q

what are the treatments for herat failure that just improve survival?

A

Beta Blockers

Ivabradine

9
Q

whar are the diuretics used for the treatment of symtpoms of heart failure?

A

loop diuretics such as furosemide and Bumetanide (used in elderly as slower effects)

10
Q

which Beta Blockers are used to block detrimental hormonal changes (adrenaline) in heart failure?

A

bisoprolol
carvedilol
metoprolol (in trials but not used )

11
Q

which 2 groups of drugs are available for the blocking of angiotensin II effects in heart failure? and give examples

A

ACEi- ramipril

ARBs- valsartan, losartan

12
Q

which drugs out of ACEi and ARBs are most effective?

A

ACEi

13
Q

what are the drugs that block the effects of aldosterone in heart failure?

A

potassium sparing diuretics such as spironolactone

14
Q

what is the mode of action of neprolysin for improving heart failure?

A

prevents metabolism of ANP and BNP and enhances their actions

15
Q

what is the mode of action of digoxin for improving heart failure?

A

improves the ability of the heart to pump and so improve cardiav status

16
Q

what is the action of isosorbide mono and dinitrate for improving herat failure?

A

vasodilators reducing preload and afterload.

17
Q

what is the action of hydralazine in the treatment of heart failue?

A

arterial dilator which improved cardiac function

18
Q

what is the action of furosemide in the treatment of heart failure?

A

loop diuretic so removes excess salt and water

19
Q

when heart failure patients are resistant to loop diuretics such as furozemide what is added to the treatment?

A

thiazide diuretics

20
Q

what are the adverese drug reactions of furozemide?

A
dehydration
hypotension
hypokalaemia
hyponatraemia
gout
impaired glucose tolerance, diabetes
21
Q

which drugs does furosemide interact with?

A
antihypertensives- causes cause renal toxicity:
profound hypotension
aminoglycosides
lithium
NSAIDs
vancomycin
22
Q

what are the 4 ways to reduce mortality in heart failure?

A

Angiotensin Blockade
Beta receptor blockade
Aldosterone blockade
ANP/BNP enhancement

23
Q

name 3 ACEi?

A

ramipril
enalalpril
lisinopril

24
Q

what are the adverse drug reactions of ACEI?

A
first dose hypotension
angioedema
renal impairment
renal faliure
hyperkalaemia
25
Q

what drugs do ACEI interact with? and what do they cause when given together?

A

NSAIDs - acute renal failure
potassium supplements-hyperkalaemia
potassium sparing diuretics-hyperkalaemia

26
Q

what is the mode of action of valsartan-sacubitril (ARNI)?

A

it is a combined vasartan and ARB and naprilysin drug, so blocks the angiotensin II receptor prevents the break down of ANP and BNP

27
Q

when are Beta Blockers used in the treatment of herat failure and why?

A

only used after patient is stabilised and “dry”. Unstabe patients rely on a sympathetic drive so if given a beta blocker this drive willl be lost.

28
Q

what is the action of ivabradine?

A

inhibitor of the If current in the sinoatrial node so reduces heart rate, it has no effect on myocardial conteactility

29
Q

what are the sideeffects of digoxin?

A

arrhthmias
nausea
confusion

30
Q

what anticoagulant is used in heary failure?

A

warfarin

31
Q

what are the treatments for heart failure?

A
furozemide ± thiazide
furosemide + metolazone
ACEi
ARB
ARNI-valsartin-sacubtril
Beta-blocker ± ivabradine
spironolactone
digoxin
warfarin