• To understand the strategies for treatment of chronic heart failure

think ABBA

• To understand the strategies for treatment of acute heart failure

THINK LMNOP

• Recognise how the apparently paradoxical use of beta blockers is of benefit

you would think beta blockers would not be of use in HF as they may slow HR, which could decrease CO… so why are they good?!

they allow for the ventricle to fill more during diastole

they can cause vasodilation which dec afterload (reducing afterload is very effective in treating HFrEF because it increases stroke volume and decreases preload, which improves EF) - rem afterload is the amount of pressure needed to push the blood out of the heart

and reduce renin release by kidney which means less RAAS which = less BV = dec BP

generally though beta-blockers use in HF is a very specialist use only and is ONLY used in secondary line care of HF in a ICU situation or coronary care unit

• Understand the mechanism of action and uses of drugs which inhibit the renin-angiotensin-aldosterone system

theres a drug compound between Sacubitril and Valsartan which act to inhibit RAAS system

so Sacubitril is actually a neprilysin inhibitor (neprilysin breaks down ANPs which act to dec BV all is explained below in detail)

and Valsartan is used to inhibit RAAS which would be activated to combat the effects of sacubitril so this ensures that bV is not increased

the compound between these two drugs in a brand name is known as Entresto