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WEEK 20:
Cardiac Failure 2: Clinical Management:
| Question | Answer |
|---|---|
| symptoms of heart failure (3) | breathlessness (especially during exertion), fatigue, and peripheral oedema |
| signs of heart failure (3) | raised JVP, pulmonary crepitations, and peripheral oedema |
| ejection fraction (EF) | how much blood ejected with each heart beat- helps measure LV systolic function |
| normal EF | >50% |
| reduced EF | <40% |
| severely impaired EF | <35% |
| all patients with LVSD should start what | angiotensin-converting enzyme inhibitor (ACE inhibitor) and beta blocker |
| all patients with pulmonary/ peripheral oedema should receive | diuretic |
| mechanism of ACE-i | renin converts angiotensin into angiotensin I, ACE converts angiotensin I into angiotensin II leading to vasoconstriction and aldosterone but ACE-i stop ACE which increase bradykinin (causing cough) |
| effect of ACE-i | reduce arterial and venous vasoconstriction (reduce after + pre load), and reduce salt/ water retention |
| how to give ACE-i | low dose then titrate up whilst monitoring urea/ creatinine & K+ |
| renal artery stenosis* 21 | narrowing at afferent arteriole of kidney so renin comes and angiotensin II constricts efferent arteriole to keep renin there to increase perfusion |
| AT1 receptor antagonist (angiotensin receptor blockers ARBS) | stop vasoconstriction and aldosterone by blocking action of AII- far less likely to give cough and given as alternative ACE-I if they cant take it |
| examples of ACE-I | |
| examples of AT1 receptor antagonists | losartan, valsartan, and cadesartan |
| B-blockers** | |
| where are beta blockers contraindicated in | CHF |
| diuretics | reduce circulating volume, preload on heart, and relieve pulmonary and peripheral oedema |
| mineralocorticoid receptor antagonists (MRA) | reduce salt and water retention and reduce left ventricular fibrosis- but caution as may cause severe hyperkalaemia (especially in combination wtih ACE-I) |
| 4 pillars** | |
| mineralocorticoid receptor antagonists (MRA) examples | spironolactone (aldosterone receptor antagonist), and eplerenone (similar to spironolactone but less anti-androgenous side effects) |
| digoxin** | |
| where does digoxin act | sodium potassium pump |
| relationship between digoxin and AF | |
| digoxin toxicity leads to (4) | anorexia, nausea, visual disturbances, and diarrhoea |
| therapeutic window of digoxin | narrow |
| monitoring |
Created by:
kablooey
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