Heart Failure

Lipid Disorde r Coagul ation Disorde rs Hyperten sion Angina, MI Dysrhyth mias

Heart Failure

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Shock, Anaphyl axis

HF Definition and risk Inability of the ventricles to pump enough blood to factors
meet the bodys metabolic demand Weakening of heart muscle is due to ageing process Heart failure is caused or worsened by other disorders: Chronic hypertension Diabetes

Mitral stenosis (inability of mitral valve to open fully)

Myocardial infarction (clot within coronary arteries) Atherosclerosis of the coronary arteries

Heart physiology
Right side of heart receives blood from venous system Send it to lungs to receive oxygen and lose CO2 Blood returns to left side of heart Heart sends the blood to other

parts of body through aorta

Volume blood received by right side must be = received by left

Heart physiology: Cardiac output

Affected by: Preload the degree to which the heart fibres are stretched to fill the chamber with blood just prior to heart contraction (systole) Afterload the pressure in the aorta that must be overcome for the blood to be ejected from the left side of the heart In heart failure: If left myocardium becomes weak, excess blood accumulates in the left ventricles. The walls of left ventricles become thicker (hypertrophy). Blood backs up into lung causes cough, shortness of

breath (esp. when lying down). Congestive heart

Heart physiology: 1.Heart contracts with a specific Characteristics

strength (contractility)
Positive inotropic effect ability to increase
strength of contraction

Type of drug cardiac glycosides

2.Heart beats a certain rate (beats per

minute)

HF Management

Lifestyle changes

Drugs

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Cardiac glycoside

ACE HF inhibitors (1/2) Diuretics Drugs

Lower BP - reduce blood volume by enhancing excretion of sodium and water. Arterial blood pressure is reduced, thus increasing cardiac output Lower preload and reduce peripheral edema by dilating the veins that return blood into heart Combined these effects will decrease workload of heart thus increase its efficiency Reduce mortality following acute MI when given early

From plant digitalis Used to be first choice, now replaced by ACE inhibitors Increase force of contraction (increase cardiac output) Slow electrical conduction through heart, resulting in fewer beats/min Combined these effects will increase efficiency of heart Therapeutic window small Side effects vomiting, diarrhoea,

Increase urine flow, thus reducing blood volume and cardiac workload, as well as reducing edema and congestion Side effect electrolyte imbalance, especially if taking cardiac glycosides together

Posphodiest erase inhibitors Brief half-life (PDE3-I)

For short-term control of acute heart failure Use only for 2 3 days For patients not responding to ACE inhibitors and cardiac glycosides Eg: milrinone, inamrinone, cilostazol

HF Drugs (2/2)
Vasodilators
High incidence of side effects For severe cases and cannot use ACE inhibitors e.g. Hydralazine and Isosorbide dinitrate (Isordil)

adrenergic blockers Reduce

symptoms, slow progression of HF Produce negative inotropic effect reduce heart rate and drop in blood pressure, thus decrease afterload and workload of heart Always used together with other drugs e.g. Carvedilol and Metoprolol