Exam 2 Flashcards
Beneficial effects of increased preload due to Na/H2O retention
Optimize stroke volume via Frank-Starling mechanism
Detrimental effects of increased preload due to Na/H2O retention
Pulmonary/systemic congestion and edema; increased MVO2
Beneficial effects of vasoconstriction
Maintain BP in face or reduced CO; shunt blood from nonessential tissues to the heart
Detrimental effects of vasoconstriction
Increased MVO2; increased afterload decreases SV and further activates the compensatory responses
Beneficial effects of tachycardia and increased contractility (SNS activation)
Maintain CO
Detrimental effects of tachycardia and increased contractility (SNS activation)
Increased MVO2; shortened diastolic filling time; beta-receptor downregulation and decreased responsiveness; ventricular arrhythmias; increased risk of myocardial cell death
Beneficial effect of ventricular hypertrophy and remodeling
Maintain CO; Reduce myocardial wall stress; decreased MVO2
Detrimental effects of ventricular hypertrophy and remodeling
Diastolic and systolic dysfunction; risk of myocardial cell death and ischemia; risk of arrhythmias; fibrosis
Factors precipitating or worsening HF
AFib, Atrial flutter, inadequate therapy
Which medication classes are negative inotropes?
Antiarrhyhmics, BB, CCB, Itraconazole
What is asymptomatic rEF
No HF symptoms w/ EF<40%
What is HFrEF
HF symptoms with EF<40%
Should a patient withhold fluid if they are fluid overloaded?
Nope
Regular exercise (walking and cycling) should be ______ in all patients with stable HF. The need for cardiac rehab should be ____ in each patient.
Encouraged; assessed
Dynamic exercise (walking, biking, etc.) to increase HR to ____% of maximum for 20-60 minutes ____ times/week.
60-80%
3-5 times/week
How many grams of sodium should a HF patient consume a day?
2-3 grams
Why would a patient have a fluid intake restriction to <2 L/day?
-Hyponatremia (<130 mEq/L)
-If tx with diuretics is difficult in maintaining fluid volume
General measures for pts with HF
-Weight monitoring (and reduction) if necessary
-Non-drug and drug tx; sx of worsening HF
-Smoking cessation
-Immunizations
-Mx and replace electrolytes (esp K and Mg)
-Appropriate thyroid disease management
-Herbal products and nutritional supplements?
Which medication classes decrease intravascular volume?
Diuretics and SGLT2-i
Which medications increase myocardial contractility?
Positive inotropes
Which medications decrease ventricular afterload?
ACE-i, vasodilators, SGLT2-i
Which medications are a neurohormonal blockade?
ARNIs, BB, ACE-i, ARB, MRAs, SGLT2-i
Med class for Stage A HF
ACEi/ARB
Med class for Stage B HF
ACEi/ARB + BB