19. heart failure 1 Flashcards
define cardiac failure
pump failure due to structural & functional disorder iimpairing the ability of ventricles to fill or eject blood decreasing CO
decompensation
in spite of compensatory mechanisms the CO not able to supply the tissue in O2
factors determining cardiac performance
- HR
- prefload and afterload
- contractility
what are the underlying causes
- MI
- IHD
- valvular pathologies
- CMP
- congential heard defects
types of heat failures
systolic = decreased contractility and EF <40%
diastolic = decreased relaxation and ej can be mild or normal
stages of NYHA
4 classes look them up on google
treatment
- prevention + non pharmacological
- drug treatment
- invasive therapy
drugs used in HF
positive ionotropic drugs
vasodilators
miscellaneous drugs for CHF
postiive ionotropic drugs
- cardiac glycosides (digoxin)
- b-agonists (dobutamine)
- PDE inhibitors (inamrinone)
vasodilators
PDE inhibitors (inamrinone)
nitroprusside, nitrates, hydralazinw
-loop diuretics, ACEi, nesiritide
Aims
decrease the preload, afterload, remodelling,
increase the contractility
what’s used in decreasing pre & after load
diuretics, vasodilators, RAAS i
what’s used in order to increase contraction
+ ionotropic agents
aim in treating chronic HF
- relieve sypmtoms
- improve hemodynamic state
- decrease hospitalization
- decrease mortality
NYHA 1-2
diuretics, ace, ARBs, b blockers, aldosterone antagonists
NYHA 3-4
duiretics, cardiac glycosides, sympathomimitics, vasodilators
RAAS inhibitors: MOA, drugs
HF activates RAAS because it decreases perfusion of kidney, renin release, promoted by SY stimulation
drugs: Captopril (ACEi)
losartan (ARB)
ACEi captopril
- decrese vasocontriction, after & preload leading to increased CO
- increase brandykinin leading to dialtion,
- decreasing aldosterone
indication: HF with reduced ejection fraction and is combined with other drugs
ARB’s losartan
competitive inhibition of angiotensin 2 on AT1 receptors
- decrease afterload and preload leading to a increase cardiac output
diuretics 1st line for? some examples
1st line for both systolic and diastolic HF, decreases preload and oafterload
- aldosterone antagonists
- potassium excreting
Aldosterone antagonists
- eplerenone, sprionolactone
- prevents salt retention, mycardial hypertrophy, hypokalemia and decreases remodeling
indication: sever hf with reduced ejectionf raction + MI
potassiu, excreteing
- relieve pulmonary HT + peripheral edema
- decrease sypmtoms of volume overload
- decrease the preload leading ot decrease cardiac work and O2 demand
- decrease the afterload leading to decreased pressure
indication: increase survival of HF patients with renal insufficiency
vaso and veno dilators
use, examples, indication, adverse effects
- decrease pre and afterload
- nitrates, hydralazine, nitroprusside
- HF w/ EF + intolerance to ACEi + BB
Heart rate controllers
ivabradine: block I.f channel ->decreasing HR
- Ranolazine - block late Na ch-> decreasing ca -> decreased contractility
BB use, examples, indication, adverse effects
-increase systolic function, reverse cardiac remodelling
-decrease HR, decrease hyper trophy
-inhibit renin reliease
bisprolol, nebivolol, metoprolol, carvedilol
- indication: HF, HF r EF
+ ionotropicdrugs
1- heart glycosides 2-B agonists 3-PDE inhibitors 4-calcium sensitizers 5-new grugs for acute HF
examples of B agonists
dobutamine
dopamine
dobutamine use, examples, indication, adverse effects
b1 stimulation -> gs-> increase in cAMP leading to + ino,dromo, chronotropy
racemic + isomer = b1 agnosits + alpha1 antagonist
-short half life, drop infusion
-indication:acute HF : cardiogenic shock, MI,heart surgery, OD on BB, acute decompensation in congestive HF
- adverse effects: tachycardia, arrythmia, tachypylaxis
dopamine use, examples, indication, adverse effects
- low dose D1 leading to decrease in NE -> vasodilation in viscera
- meduim dose b1 stimulation -> +ionotropy
- high dose: alpha1 -> vasoconstriction
- indication: cardiogenic shock, increase perfusion in kidneys + splanchnic area
- adverse effects: tachycardia, tolerance, bad pharmacokinetics
PDE inhibitors use, examples, indication, adverse effects
-increase cAMP, vasodilation leading to a decrease in TPR, used in acute HF
adverse effects: thrombocytopenia , hepatotoxic, HF
contraindicated in aortic stenosis, HCM
examples:
bipyridines: amirone, milrinone
methylxanthine derivatives: theophyllin, aminophyllin
other: vesnarinon
calcium sensitizers
enhancement of ca sensitivity of tropinin c myofibrils,
they dont increase cAMP or ca
indication: acture decompensation of severe chronic HF
benzimadazoles: primobendan: oral,iv, inhibit PDE, narrow T.I
levosimendan: infusion IV, open ATP dep K ch. leading to vasodilation
new drugs for acute HF:
-endothelin 1 ATG: bosetan ambrisentan
oral, toxic, (i) pulm HT, raynaud
-endothelin convertase inhibitor: phosphoramidon
-BNP: nesiritide, IV bolus t1/2 about 20 min. (I) absolute refractory HF
leads to an increase in cGMP leading to VD
its nephrotoix
-othersL coEZ Q10, aliskiren, serelaxin
