Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Therapeutics/Pharmacology > Cardiac Failure > Flashcards

Cardiac Failure Flashcards

1
Q

Symptoms of cardiac failure

A

Oedema
Exercise intelerance
SOB
Fatigue
Tachycardia or irregular heart beat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the physiological responses to heart failure

A
  1. RAAS system (Renin angiotensin aldosterone)
    -leads to sodium and water retention
    -vasoconstriction
  2. Norepinephrines
    -Tachycardia
    • vasoconstriction
  3. Endothelium’s (peptides that cause vasoconstriction and increase BP)
  4. Beta adrenergic sensitisation
  5. Hypertrophy, Ischemic, arrhythmia
  6. Necrosis, fibrosis, left ventricular remodelling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What cause of heart failure leads to structural abnormality of the heart

A

Hypertension which leads to LV hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What cause of heart failure lead to functional abnormality of the heart

A

Ischemia from coronary occlusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the sympathetic nervous system response to decrease in blood pressure

A

Decrease in Bp activates sympathetic nervous system
Activation of Beta 1 adrenoceptors of the heart which leads to increased cardiac output
Activation of Alpha 1 adrenoceptors on smooth muscles which leads to increased peripheral resistance (vasoconstriction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe RAAS system response in dicrease in blood pressure

A

-Blood flow to kidneys low when low BP
-Activation of renin
-Renin causes Angiotensin 1 release
-Angiotensin 1 is converted into angiotensin 2
-Angiotensin 2 causes release of aldosterone
-Aldosterone causes retention of sodium and water
-Increases blood volume and cardiac output also increased.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 5 main causes of Cardiac failure

A

Hypertension
Coronary artery disease
Cardiomyopathy
Valvular heart disease
Myocardial infarction

Thyrotoxicosis
Anaemia
Alcohol excess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which drugs can precipitate cardiac failure

A

Oestrogens
Steroids
(Non-dihydropyridine) Calcium channel blockers
Beta-blockers
Non-steroidal anti-inflammatory drugs (NSAIDs)
Excessive diuretics
Tricyclic antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Non drug measures to treat heart failure

A

Exercise training
Flu immunization
Reduction in alcohol consumption
Cessation of smoking
Correction of anemia
Review

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Drug measures for cardiac failure

A

ACE inhibitors
Beta blockers
Spironolactone
Isosorbide-hydralazine as adjunctive therapy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Stepwise approach in management of chronic heart failure

A
  1. ACE inhibitor
    -If the ACE-I cant be tolerated, an Angiotensin II receptor blocker can be used but this requires discussion with a specialist.
    -If there the fluid retention is mild, a thiazide diuretic can be used, such as HCTZ (Ridaq), if it’s more significant, a loop diuretic Furosemide (Lasix)
  2. Beta blockers - Carvedilol
  3. Spironolactone
  4. Digoxin- discussed with specialist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the potential adverse effects of ACE Inhibitors

A

Hyperkalemia
Hyponatremia
Hypotension
Renal dysfunction due to fall in GFR
Acute angioedema (rare)
Low output states
NSAIDS therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the contraindications of ACE inhibitors

A

Renal artery stenosis
Hyperkalemia
Pregnancy
Previous angioedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How would you manage ACE inhibitor related angioedema

A

-Withdrawal of ACE inhibitor 1
-Supportive treatment
-Corticosteroids, antihistamine, Adrenalin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which is the preferred antagonist between ACE inhibitor and Angiotensin receptor blocker

A

ACE inhibitor is better than Angiotensin 2 blockers

12% Lower risk of death
20% lower risk of lethal arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Adverse effect of increased sympathetic nervous system in cardiac failure

A

Myocyte hypertrophy and death, dilatation
Ischemia
arrhythmias

17
Q

Mechanism of action of beta blockers

A

Mechanism of action multifactorial
Protect against cardiotoxic effects of catecholamines
Decrease heart rate
Reduce renin secretion (blockade of renal B-receptors) Anti-arrhythmic
Vasodilating, anti-oxidant effects (carvedilol)

18
Q

What are the long term effects of beta blockers

A

Reduce mortality
Improve LV ejection fraction

19
Q

Examples of beta blockers

A

Carvedilol, bisoprolol, metoprolol

20
Q

Indications of beta blockers

A

Cardiac failure with fluid retention

21
Q

Contraindications of beta blockers

A

Bradycardia (<60bpm)
2nd or 3rd degree heart block
Symptomatic hypotension
Hyper reactive airway
Peripheral artery disease

22
Q

Can beta blockers be stopped suddenly or gradually

A

Never stop them abruptly!

23
Q

Effects of aldosterone

A

Increased sodium and water retention
LEFT VENTRICULAR FIBROSIS & HYPERTROPHY
Reduced K+ and Mg + + (due to fluid retention?)
Reduced arterial compliance, endothelial function

24
Q

Indication for Spironolactone

A

NYHA III & IV despite treatment with ACE-I & β-blocker

25
Q

Side effects of Spironolactone

A

Hyperkalemia
Affinity for other steroid receptors leading to gynaecomastia, hirsutism, sexual dysfunction.

26
Q

What type of diuretic is thiazide

A

LOW-CEILING
Low dose thiazide

27
Q

Mechanism of action of diuretics: Furosemide, Thiazide and Spironolactone

A

Furosemide
Inhibit Na-K-Cl
co-transporter

HCTZ
Inhibits NaCl
channel

Spironolactone
Aldosterone antagonist

28
Q

Side effects of furosemide

A

Electrolyte disturbance
Reverse dose related hearing loss (Ototoxicity)
Hypovolaemia
Hyperglycaemia
Hyperureceimia
Hypersensitivity reaction

29
Q

Side effects of thiazide diuretic

A

Electrolyte disturbance
Hyperureceimia
Hypercalcemia

30
Q

Factors increasing digoxin toxicity

A

Elderly
Myocardial infarction
Hypoxaemia
Hypokalaemia, hypomagnesaemia, hypercalcaemia
Hypothyroidism
Quinidine, verapamil, amiodarone
Cardioversion

31
Q

Where is Digoxin contraindicated

A

Hypertrophy
Hypokalemia
AV block

32
Q

Features of Digitalis toxicity

A

Gastro: nausea, vomiting, diarrhoea, anorexia
Neuro: confusion, fatigue, depression, insomnia, facial pain, vertigo, coloured vision
Cardio,: arrhythmias, palpitations, syncope
Blood: high digoxin concentration

33
Q

Symptoms and signs of fluid overload

A

Dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, oedema
Tachypnoea, cyanosis, hypotension, raised JVP, displaced apex, S3 gallop rhythm, tender hepatomegaly, pulmonary oedema

34
Q

How to treat pulmonary oedema

A

Fowlers position
Administer oxygen

35
Q

Treatment in hypotension patient with acute heart failure

A

Inotropic support: Dobutamine

36
Q

Treatment of acute heart failure

A

Diuretics and Vasodilators
(Morphine, Nitrates And possibly inotropes)

Therapeutics/Pharmacology (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions