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CHF Flashcards

1
Q

Systolic Heart Failure

A

Ventricles cant generate enough SV- decreases CO, and Drop-in BP

CO = HR X SV,

SV inverse to Afterload- decrease Diastolic pressure

Decrease EF

Flappy, Dilated and Compliant myocardium

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2
Q

Decrease in Contractility in SHF

A

MI- Anterior/Lateral

Dilated CardioMyopathy - (Flappy Heart)

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3
Q

Increase in Preload with Decrease Contractility SHF

A

Mitral and Aortic Regurgitation

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4
Q

Other SHF conditions

A

Tachyarrythmias and Bradyarrythmias

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5
Q

Diastolic Heart Failure

A

EF maybe normal (preserved)- decreased filling/preload and increase in Afterload

Stiff, Fibrotic, Non-compliant myocardium

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6
Q

Decrease PReload DHF

A

MI,
Restrictive CM,
Constrictive Pericarditis

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7
Q

Increased Afterload

A

Hypertension,
Aortic stenosis,
Coarctation of Aorta (Narrowing of aorta)
Hypertrophic Constrictive Cardiomyopathy- Congenital (Thick myocardium)

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8
Q

What leads to RHF

A

LHF

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9
Q

Increase Afterload RHF

A

Pulmonary stenosis
Pulmonary hypertension
Pul. Embol
Cor. Pulmonale- COPD V/Q= <0.8

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10
Q

Increase in Preload RHF

A

Tricuspid and Pumonary Regurg (Not common)- common in IV drug users- Staph infection-infection of valves

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11
Q

Decrease in contractility

A

Inferior MI, Myocarditis

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12
Q

High Output HF is due to

A

underlying CVD

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13
Q

Symptoms of HOHF

A 
Severe Anemia (hypoxia)
Wet Beri-Beri (Thiamine deficiency- Alcoholics, CN6 palsy, Deficiency of PDH)
Thyrotoxicosis
Pregnancy (Volume overload)
AV Fistula (hemodialysis complication)
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14
Q

Lactic acid accumulation in Myocardium

A

Vasodilation causes AV shunting (Fast shifting of blood from Atria to ventricle)

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15
Q

Receptors in Carotid sinus for BP

A

BAroreceptors

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16
Q

Detects low CO

A

receptors- LBP- Medulla- CArd. Acc Center- SNS- Increases Contractility (B1 receptors) inc. SV, HR

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17
Q

SNS effects

A

Sends fibers to Venous and arterial system- release epi. (a1 receptors)- Constricts Arterial Smooth muscle- Inc TPR= Increase BP

Constriction of V Smooth Muslce- Inc Venous return = Inc Preload = Inc SV=
Inc. CO = Inc- BP

a1 receptor in kidney = dec. GFR= inc Fluid retention= Inc Preload = Inc SV -= Inc CO = Inc BP

JG cells- b1 recep- inc. Renin= ACE in lungs (with angiotensinogen in Liver)= AT 2

Beta blockers helpful

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18
Q

Functions of AT2

A

Stim Post pituitary= ADH prod = Water retention= inc. BV = Inc Preload = Inc. SV= Inc Co= Inc BP

Vasoconstriction of arterioles= Inc TPR = Inc BP

Adrenal Gland (Zona G)- Secretes Aldosterone= Increase Na reabsorption in DCT and H20 Reabsorption= Inc BV = Inc Preload = Inc. SV= Inc Co= Inc BP

ACE inhibtors helpful

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19
Q

CHF symptoms

A

Pulmonary veins have a lot of blood- Inc pressure in Pulmonary veins= Leaking fluids- Pulmonary Edema (inc pressure in P. capillaries)= Hypoxemia

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20
Q

Symptoms of hypoxemia

A

Dyspnea
Cough (Dry)
Orthopnea (difficulty breathing when lying flat)
Paroxysmal Nocturnal Dyspnea- (Difficulty breathing)
Crackles in lungs (Rales) inspiration

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21
Q

Accumulating of Blood in Sup. Vena Cava

A

Inc Internal Jug Vein Pressure= Jug Vein Distention

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22
Q

Accumulation of blood into inf Vena Cava

A

inc Pressure due to pressure on liver, Decrease perfusion of Liver

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23
Q

Hepato-jug Reflex

A

> /= 3cm Inc in JVD

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24
Q

increased pressure in the liver and spleen due to accumulation causes

A

hepato-spleno-megaly and ascites

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25
Accumulation of blood in GIT
Ascites- Nausea and abd. pain and | obstruction- dull precursive abdomen- Fluid wave test
26
Accumulation of blood in LE
Calf Edema- Pitting (Bilateral edema)
27
Decreased perfusion of extremities
Cold, Clammy, pale, Diaphoretic
28
Heart Sounds in CHF
Sys HF- S3 | Dias. HF- S4
29
Diagnostic clues for HF
CXR BNP >400pg Echo Cardiac Catheterization
30
Classes of NYHA CHF
1- Extreme exertion 2- Mod. ex 3- Mild 4- At rest (Emergency)
31
What should be treated first regardless of Class of HF
Underlying disease Restrict Na+(<2g/day and H2O (<2L/day) intake
32
RAAS
Decrease perfusion of Kidneys = Stim. JG cells = Release Renin = Angiotensinogen to AT1 ACE converts to AT2
33
Problems with AT2
Vasoconstriction- Decrease lumen diameter- inc TPR (Afterload inc)- Inc BP Ant Pitutary- ADH- Dec Urine output- Inc. Water reabsorp.= inc. Bp= inc. EDV = Inc. Preload Adremal gland= Aldosterone= inc NA and Water reabsorption= Inc BV= Inc EDV = Inc Preload
34
Class 1 drugs
ACE inhibitors- Inhibit ACE which decreases AT2 and reduces stress Captopril Enalapril Lisinopril Benazepril
35
What if the patient cannot tolerate ACE inhibitors- Dry cough and angioedema Class 1
ARBs (AT2 Receptor blockers)- Lazartan Valsartan Candesartan
36
Class 3 Drugs
Aldosterone antagonist- Spirnolactone Eplerenone Dec Remodelling, K+ sparing
37
Class 3 drug that can be used if normal fail
Entresto
38
MOA of Entresto
HF= Inc BNP = Blocks AT2 actions decrease afterload Problems- Neprilysin- Breaks down BNP Neprilysin Inhib to prevent breakdown
39
Neprilysin Inhibitors to inc BNP and increase action
Sacubatril + ARB (Valsartan) = Entresto
40
SNS effects
b1 receptors Dec CO= inc. SNS= inc. HR (b1 receptors on SA node and Myocardium = Inc BP= inc Contractility= inc CO = inc BP= inc O2 demand a1 on renal arterioles= inc. renin and vasoconstriction= inc TPR= Inc BP and in Afterload
41
Class 1 SNS drugs
ACE inhib and ARb cant tolerate, give b-blockers Metoprolol- b1 only selective Carvedilol- both a1 and b1 activity negative chronotropic (dec HR) and neg Ionotropic (dec Contractility) negative renin release
42
Where are BEta blockers contraindicated
Decompensated HF
43
Class 4 SNS drugs for contractility (last-ditch effort to save patient)
Digoxin (+ve inotrope, -ve Chronotropic)
44
Dobutamine class 4
Decomp. HF | Cardiogenic shock
45
Class 2 (Diuretics) for edema
Loop- Furosemide (Lasix) | Thiazide- Hydrochlorothiazide & metolazone)
46
Metolazone
significant edema start at 2mg Furosemide sometimes add Metolazone to pull out more water and not inc. Furosemide Dosage
47
loop diuretics MOA-
Act on Loop- inhibit Na+/K+ cotransporter | Increase buildup of Na, k and H2O= Increase urination (25%) Decreases EDV= Dec Preload
48
Thiazide MOA
Inhib Na/Cl transporter- dec. reabsorption (10-15% GFR) inc. Urine output= Dec.BV= Dec. EDV= Dec Preload= Dec Stress
49
Class 3 Drugs
Hydralazine Isosorbide Dinitrate Only use when ACE1 and ARBS fail
50
MOA of Hydralazine
Hydralazine= well-tolerated in African American patients, safe for pregnancy Acts on art. SM= Inc NO= inc Guanylyl Cyclase- GTP to cGMP- with Protein kinase- Promotes inhibits Ca entry and relax smooth muscle
51
MOA of ISD
Acts on art. SM= Inc NO= inc Guanylyl Cyclase- GTP to cGMP- with Protein kinase- Promotes inhibits Ca entry and relax smooth muscle
52
The difference in ISD and Hydralazine
Arterial relaxation= dec. TPR, Dec. Afterload in Hydralazine ISD- relaxation of venous system= Dec. right Venous return, Dec EDV = Dec. Preload= Dec. Stress
53
Decomp. HF
``` L- lasix- Edema M- Morphine N- Nitrates (hydralazine, ISD- dec. AL and Chest pain) O- OXygenation- BIPAP, CPAP P- position- Decrease fluid by gravity ```
54
Ivabradine
HCn channel Blocker used in patients on b blockers or contraindicated on b blocker Inc. SV= Slow Heartrate 6hr half-life 2 times a day ``` side eff- bradycardia no eff. on rate control in a-fib luminous phenomena in eye Contraindicated in pregnancy, adv. Heart blocks and 3A4 inhibtors ```
55
Adverse effects of ACE inhibitors
``` Postural hypertension Renal insuffeciency Hyperkalemia- monitor K+ while using simultaneously with Spirnolactone Creatinine increase Teratogen ```
56
Adverse effects of ARBs
similar to ACE inhibtor | hoewever, lo effects on Cough and angioedema
57
Thiazide Diuretics Adv. Effects
``` Hypokalemia Hyponatremia Hypomagnesemia Hyperuricemia Hypovolemia Hypercalcemia Hyperglycemia ```
58
Loop Diuretics Adv. effects
``` Acute Hypovolemia\ hypokalemia Hypomagnesemia Ototoxicity- hearing loss Hyperuricemia ```
59
K+ Sparing Diruretics Adv. Eff
Hyperkalemia | Gynecomastia
60
Adv Effects of Neprilysin inhib
Same as ARB and ACE
61
Adv. Effects of Digoxin
``` narrow TI Anorexia Nausea Emesis Blurred vision Arrhythmias due to Na+/K+ ATPase inhibition Hypokalemia inhibitors of P-gp Clarithromycin, Verapamil, and Amiodarone can cause worse side effects to digoxin as they act on P-gp ```

Pharmacology (19 decks)

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