MD3001 Cardiovascular Pathology/Pharmacology/Treatment Questions

1. Why can Sacubitril/Valsartan (Entresto) not be administered concurrently with ramipril?

Ramipril is an ace inhibitor (think it ends in pril)

ACE inhibitors have a small risk of causing a life threatening side effect known as Angioedema (swelling that is similar to hives, but the swelling is under the skin instead of on the surface)

it occurs in the throat and can cause complete closure of the larynx causing no respiration to be able to occur

Entresto also has this side effect as a risk, although it is uncommon it can still potentially occur and if both are taken together then the risk is heightened and is more likely to occur. therefore they are never administered together.

2. Why do neural reflex responses to decreased baroreceptor activity potentially worsen cardiac failure?

decreased baroreceptor activity is due to a decrease in BP.

so this question is really asking - what reflexes which are used by the body to INCREASE BP contribute to worsening HF and why?

TPR is increased to help push the blood through the systemic circulation

RAAS - this is the MAIN system for increasing BP (renin angiotensin aldosterone system)

it causes an increase in preload, afterload and volume all which contribute to an increasing amount of workload for the heart which overall worsens HF

3. What are the early (hours to days) complications of an acute STEMI?