Difference between revisions of "Heart Failure, Treatment"
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| + | ==Introduction== | ||
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| + | ==Goals of Treatment== | ||
*Cure | *Cure | ||
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*Slow/Prevent Disease Progression | *Slow/Prevent Disease Progression | ||
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*Symptomatic Relief | *Symptomatic Relief | ||
| + | Treatments vary from surgical correction of underlying conditions, such as correction of a PDA, to management changes and pharmacological treatments. | ||
| − | === | + | ==Management Changes== |
| − | + | #Avoid strenuous exercise | |
| − | + | #Reduced Salt Diets (Reduces Preload) | |
| − | + | #Potassium Supplements | |
| − | + | #Taurine Supplements (Cats with dilated cardiomyopathy) | |
| − | + | #L-carnitine Supplements (Dogs with dilated cardiomyopathy) | |
| − | + | #Nutraceuticals (e.g. Omega-3 fatty acids, Anti-oxidants, Co-enzyme Q10) | |
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Heart failure patients can suffer from cardiac cachexia due to the high metabolic demands of this condition. Make sure the patient is eating enough calories per day to maintain their body weight. | Heart failure patients can suffer from cardiac cachexia due to the high metabolic demands of this condition. Make sure the patient is eating enough calories per day to maintain their body weight. | ||
| + | ==Pharmacological Intervention== | ||
| + | The following terms are usfule when desribing the effects of various pharmacological agents: | ||
| + | *Preload=amount of maximal myocardial stretch (During Diastole) | ||
| + | *Afterload=amount of maximal myocardial tension (During Systole) | ||
| − | + | Drug treatments can be used to: | |
| − | + | *Decrease Preload (Decreases venous tone & fluid volume) | |
| − | + | *Decrease Afterload (Increases flow by decreasing arterial tone) | |
| − | + | *Increase Myocardial Systolic Function | |
| − | + | *Increase Myocardial Diastolic Function | |
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=====Decrease Preload===== | =====Decrease Preload===== | ||
Revision as of 19:39, 25 October 2010
Introduction
Goals of Treatment
- Cure
- Slow/Prevent Disease Progression
- Symptomatic Relief
Treatments vary from surgical correction of underlying conditions, such as correction of a PDA, to management changes and pharmacological treatments.
Management Changes
- Avoid strenuous exercise
- Reduced Salt Diets (Reduces Preload)
- Potassium Supplements
- Taurine Supplements (Cats with dilated cardiomyopathy)
- L-carnitine Supplements (Dogs with dilated cardiomyopathy)
- Nutraceuticals (e.g. Omega-3 fatty acids, Anti-oxidants, Co-enzyme Q10)
Heart failure patients can suffer from cardiac cachexia due to the high metabolic demands of this condition. Make sure the patient is eating enough calories per day to maintain their body weight.
Pharmacological Intervention
The following terms are usfule when desribing the effects of various pharmacological agents:
- Preload=amount of maximal myocardial stretch (During Diastole)
- Afterload=amount of maximal myocardial tension (During Systole)
Drug treatments can be used to:
- Decrease Preload (Decreases venous tone & fluid volume)
- Decrease Afterload (Increases flow by decreasing arterial tone)
- Increase Myocardial Systolic Function
- Increase Myocardial Diastolic Function
Decrease Preload
- Benefit: To relieve congestion & edema
- Techniques
1. Diuretics: Decrease blood volume by increasing sodium loss from the kidneys
-Loop Diuretics (Act on the renal Loop of Henle)
- Frusemide
-Thiazide Diuretics (Act on the renal Distal Convoluted Tubule)
- Chlorothiazide
- Hydrochlorothiazide
-Potassium Sparing Diuretics (Act on the renal Collecting Duct)
- Spironolactone
- Amiloride
2. Venodilation: Dilation of veins causes decreased venous pressures, blood redistribution, increased capacitance
-Venodilators
- Glyceryl trinitrate
-Balanced Vasodilators
- ACE inhibitors
- Alpha-antagonists
- Nitroprusside
Side Effects of Preload Reduction: hypovolemia, dehydration, hypokalemia, hyponatremia
Decrease Afterload
- Benefit: Reduce resistance to outflow, reduce cardiac work by decreasing systolic myocardial tension, increase blood flow
- Techniques
1. Arterial Vasodilators
- Hydralazine
2. Balanced Vasodilators
- ACE Inhibitors
enalapril (dogs & cats)
benazepril (cats)
Side Effects of ACE Inhibitors: vomiting, anorexia, diarrhea, hypotension, azotemia
Increase Myocardial Systolic Function
- Benefit: Helps with dilated cardiomyopathy & mitral valve disease (Dog & Cat)
- Contraindicated: Animals with hypertrophic cardiomyopathy (Dog & Cat)
- Techniques
1. Positive Inotropes
- Digitalis Compounds (e.g. digoxin, digitoxin)
- Calcium Sensitiser/Phosphodiesterase III. Inhibitor (e.g. pimobendan)
- Pure Phosphodiesterase Inhibitors (e.g. milrinone, amrinone)
- Catecholamines (e.g. dobutamine, dopamine)
Advantages:
-Stimulates myocardial contractility to improve cardiac output regardless of preload
Disadvantages:
-Increased myocardial work causes increased myocardial oxygen demand
Increase Myocardial Diastolic Function
- Benefit: Helps with hypertrophic cardiomyopathy and myocardial fibrosis where ventricular filling is compromised
- Techniques
1. Beta Blockers (e.g. atenolol, propranolol)
2. Calcium Channel Blockers (e.g. diltiazem)