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Title: Clinical Trials/ An overview
Description: This is a lecture on Anti-arrhythmic agents/ some old, some new as part of the St. Georges University Biomedical Science course in the Human Cardiovascular and Respiratory Pharmacology module.
Description: This is a lecture on Anti-arrhythmic agents/ some old, some new as part of the St. Georges University Biomedical Science course in the Human Cardiovascular and Respiratory Pharmacology module.
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Definition of Heart Failure
Complex of symptoms:
SOB
Fatigue
Congestion (venous congestion - stagnant)
Due to an impairment of the hearts ability to empty or fill properly
Leading to inadequate perfusion of tissues (less O2) during exertion and retention of fluid
Myocardial Infarction
Collapse due to hypotension and arrhythmia
Acute Coronary Syndrome - all conditions together (MI, Angina, etc
...
If BP is already ow (hypotensive) - its harder to treat as the drugs will
decrease BP further
Surgical correction of valvular lesions/congenital malformation
Removal of precipitating causes
Anaemia, thyrotoxicosis, fluid overload, increased dietary salt intake, obesity, pulmonary
embolism
Arrhythmias
Poor compliance with treatment
Drugs: Beta blockers, salt retaining drugs (NSAIDS, steroids)
Relief of symptoms
Non-pharmacological management
Rest
Dietary restriction of sodium and H2O
Correction of obesity, smoking, high cholesterol
Drug therapy
Diuretics
Vasodilators (inc
...
g
...
g
...
renal impairment)
Epleronone
Less painful gynaecomastia than spironolactone
Less effective than spironolactone but less side effects
Reduces CVS mortality, hospitalisation and sudden death
Can cause hyperkalaemia and renal dysfunction
Digoxin
Inhibits Na-K ATPase pump - increasing Na which inactivates the Na-Ca exchanger
increasing Ca levels
Increases force of contraction
DOESN'T IMPROVE SURVIVAL (like diuretics)
Very long half life - can lead to toxicity and arrhythmias
Other effects:
Decreases AV conduction
Increase in vagal activity
Decreases heart rate
Uses:
Slowing ventricular rate in rapid AF
Treatment of HF in patients who remain symptomatic despite being on diuretics and
ACEi
Slight inotropic effect
Side effects:
Nausea/vomiting
Arrhythmias
Confusion
Toxicity enhanced by hypokalaemia
Withdrawal
Can cause clinical deterioration if patient is already on diuretic +/- ACEi and digoxin is
removed
CRT-P/D = Pacemaker
LVAD = Left Ventricular
Assess Device
Cardiac - Resynchronisation Therapy (RCT)
Using atrial-synchronised bi-ventricular pacing
Indicated for patients with severe symptoms and intra-ventricular conduction delays (i
...
QRS >120 msec)
Leads to dys-synchronous LV contraction, impaired emptying
Can reduce symptoms, improve functional capacity and increase survival
Surgery
Ventricular assist devices used before:
Cardiac transplantation
Summary
Diuretics
Alone alleviate symptoms but do not improve heart function or mortality
ACEi
Improve LV dysfunction, CV mortality and total mortality but do not appear to protect
against sudden death
Digoxin
Can improve symptoms, reduce hospitalisation but no impact on survival
Beta-blockers
Reduce mortality in mild to moderate CHF, reduce hospitalisation, improve symptoms
Benefit not clear in class I or class IV
Reduction in mortality may not be a class effect (metoprolol vs atenolol)
Spironolactone
Reduce CV, total mortality and hospitalisation
Title: Clinical Trials/ An overview
Description: This is a lecture on Anti-arrhythmic agents/ some old, some new as part of the St. Georges University Biomedical Science course in the Human Cardiovascular and Respiratory Pharmacology module.
Description: This is a lecture on Anti-arrhythmic agents/ some old, some new as part of the St. Georges University Biomedical Science course in the Human Cardiovascular and Respiratory Pharmacology module.