CVS Therapeutics Flashcards
What is evidence based medicine?
The conscientious, explicit, and judicious use of current best evidence in making decisions about care of individual patients.
What are the main signs of increased/excessive preload?
Evidence of congestion e.g. pulmonary oedema, ascites, peripheral oedema, pleural effusion and venous congestion.
What types of drugs are used to decrease preload and treat signs of congestion? Can you give drug examples?
Diuretics e.g. Furosemide, Spironolactone
Venodilators e.g. Glyceryl trinitrate, nitroprusside
How does excessive afterload affect perfusion? How does this happen? How will the patient appear?
Excessive afterload increases myocardial work (because there is increased resistance to ejection) and diminishes perfusion. Patients are likely to be pale or cold.
In mitral regurgitation, will it help to reduce afterload?
Yes, because it will decrease the resistance to ejection and so less should be regurgitated due to the pressure.
What types of drugs are used to decrease afterload? Can you give drug examples?
Arteriodilators & balanced vasodilators - ACEi, Pimobendan, Amlodipine, hydralazine.
What types of drugs are used to improve systolic function? Can you think of any conditions when these may be used?
Inotropic agents may help to increase systolic function.
Systolic dysfunction can be seen in DCM and later stages of mitral valve disease.
When the heart muscle is excessively hypertrophied (e.g. HCM), what happens to ventricular relaxation? What types of drugs are useful to improve diastolic function?
It is poor, and drugs that help it to relax (calcium channel blockers e.g. diltiazem), slow heart rate (beta blockers e.g. propanolol, atenolol) or reduce fibrosis (e.g. ACEi) may help.
What types of drugs can be used to optimise cardiac rate and rhythm? What is it likely their signs are due to?
Their signs are likely due to tachyarrhythmias or bradyarrhythmias. Drugs used to do this are anti-arrhythmic drugs.
