Term
| clinical hallmarks of heart failure due to systolic dysfunction |
|
Definition
| decrease in ejection fraction and stroke volume + venous congestion (pulmonary and peripheral edema) |
|
|
Term
|
Definition
low cardiac output ->
fatigue, tachycardia, hypotension, exercise intolerance |
|
|
Term
|
Definition
| venous return exceeds stroke folume -> dyspnea, pulmonary edema, right heart failure, peripheral edema |
|
|
Term
| drugs to improve symptoms of heart failure (4 categories) |
|
Definition
decrease preload - diuretics, nitrate vasodilators
decrese afterload - arteriolar vasodilator
decrease prload and afterload via balanced vasodilation - ACEI
increase ventricular contractility - positive inotropic agent |
|
|
Term
| drugs to reverse cardiac remodeling and increase longevity |
|
Definition
| blocking angII, aldo and adrenergic receptors |
|
|
Term
| how do loop diuretics (furosemide) help CH? how do they not? |
|
Definition
decreases ECF volume, decreases venous return = preload; decreases congestive symptoms
don't improve survival |
|
|
Term
| drugs to decrease cardiac preload |
|
Definition
| nitrate vasodilators - isosorbide mono/di-nitrate |
|
|
Term
|
Definition
-pril
increase ejection fraction and stroke volume, decrease congestive symptoms, reverse cardiac remodling, increase longevity |
|
|
Term
| Angiotensin Receptor Blockers |
|
Definition
-sartan
increase ejection fraction and stroke volume, decrease congestive symptoms, reverse cardiac remodling, increase longevity |
|
|
Term
ACE inhibitors effect on
venous return
afterload
left ventricular end diastolic volume
RBF
GFR
filtration fraction
MAP
HR |
|
Definition
1. venodilation -> decreased venous return (preload) -> LV-EDV and LV-EDP and LAP (wedge pressure) decrease
2. arteriolar dilation -> decr afterload (TPR) -> incr EF and SV -> decr LV-EDV, LV-EDP, LAP
3. incr SV, decr LV-EDV -> decr LV wall stress -> decr pulmonary congestion
4. RBF and GFR incr, RBF increases more -> incr FF -> diuresis
5. MAP and HR - no change or slight decrease |
|
|
Term
| another way to acheive balanced vasodilation (besides ACEIs) |
|
Definition
nitrate venodilator = isosorbide dinitrate + arterial vasodilator = hydralazine
incr SV, EF, exercise tolerance
decr RV and LV filling pressure, LV EDV, V wall stress and pulm cong
decr mortality, esp in blacks
incr NO -> decr remodeling |
|
|
Term
| drugs which decrease backward failure, reverse cardiac remodeling and increase longevity |
|
Definition
| aldosterone receptor antagonists = spironolactone and eplerenone |
|
|
Term
| spironolactone vs eplerenone |
|
Definition
S has short T1/2 and doesn't cause hyperkalemia as much
E doesn't cause gynecomastia, breast pain, azoospermia, hirtuism |
|
|
Term
| drugs that reverse cardiac remodeling leading to increase in EF, SV and longevity |
|
Definition
Beta Blockers "-olol"
prevent remodeling of myocardium caused by excessive sympathetic stimulation
decrease suden death by preventing bentricular dysrhythmias
antianginal
"start low, go slow" |
|
|
Term
| drugs that decrease pulmonary congestion by increasing EF and SV and have marginal effect to increase longevity, but don't reverse cardiac remodeling |
|
Definition
digoxin
- direct positive inotropic effect
inhibits N/K ATPase (binds to phosphorylated aspartate) -> incr IC Na -> slows extrusion of Ca -> incr Ca in SR -> incr myocardial contractility |
|
|
Term
good and bad effects of digoxin
(3 engineer brothers) |
|
Definition
good mechanical (direct) - increase myocardiac contractility
good electrical (indirect) - increase vagal/ decrease SNS -> decr HR, AV conduction, automaticity, incr effective refractory period
bad electrical (direct) - decr phase 4 membrane potential difference, incr automaticity (PACs and PVCs), AV block |
|
|
Term
|
Definition
HF from systolic dysfunction refractory to ACEI and diuretics
HF w/ atrial fibrillations - enhances ventricular contractility |
|
|
Term
| drugs that enhance the bradycardia and decrease in AV conduction produced by digoxin: |
|
Definition
verapamil and diltiazem = Ca channel blockers
beta blockers |
|
|
Term
|
Definition
"pumps fine but can't fill"
if it can't relax, can't have a normal starling curve |
|
|
Term
| prevention of diastolic dysfunction |
|
Definition
tx HTN to prevent LVH
tx ischemia caused by CAD w/ antilipemic drugs, antianginal drugs, or CABG
valve replacement in aortic stenosis |
|
|
Term
| clinical hallmarks of HF caused by diastolic dysfunction |
|
Definition
| pulmonary congestion, dyspnea, decreased exercise tolerance despite the fact that EF is >50% |
|
|
Term
| Tx HF caused by diastolic dysfunction |
|
Definition
Relieve sx - decrease pulmonary venous pressure at rest and during exercise.
Reverse LVH - increase ventricular compliance and filling
Reverse remodeling of LV - block aldosterone receptors
Decrease heartrate - prolong diastole - better filling
Prevent ischemia - makes wall stiffer |
|
|
Term
| Drug to decrease left ventricular diastolic pressure and pulmonary pressure |
|
Definition
Diuretics
decrease blood volume |
|
|
Term
|
Definition
ACE inhibitor or ARB
Ang II - mitogenic -> hypertrophy
aldo - stimulates collagen synthesis and deposition |
|
|
Term
| Drug to prolong diastolic filling |
|
Definition
| Beta blockers - reduce heartrate |
|
|
Term
| Digoxin for tx of diastolic heart failure |
|
Definition
DONT DO IT
digoxin decreae HR via central effect to increase efferent vagal nerve activity, but it's difficult to titrate and causes toxicity |
|
|
Term
| Which patients get ACE inhibitors or ARBs? |
|
Definition
| everyone with heart failure |
|
|
Term
| Which patients get furosemide |
|
Definition
| pts w/ systolic dysfunction; use with care in pts w/ diastolic dysfunction |
|
|
Term
| symptoms of cardiogenic shock |
|
Definition
hypotension
tachycardia with a thread ulse
tissue hypoperfusion - cold, clamy skin, decreased urine output, altered mental state
pulmonary edema
tx w/ NE, DA, dobutamine |
|
|
