Heart Failure Flashcards
1
Q
Heart Failure
A
occurs when hear tis unable to meet the body’s metabolic needs
2
Q
Associated with conditions including
A
- Coronary artery disease (CAD), MI - affects supply of nutrients to cardiac muscle
- Valve defects, chronic hypertension (HTN) - heart must pump more powerfully to eject blood
- DM
3
Q
Prevention is the best strategy through appropriate lifestyle and healthcare choices
A
- exercise regularly
- eat a healthy diet
- don’t smoke
- effective management of CAD, HTN, DM
4
Q
Nutritional Therapy Heart Failure
A
- education regarding diet and weight control are critical to the patients control of chronic heart failure
- due to edema the patient should be on a sodium restriction and a fluid restriction
- fluid restriction 1.5-2 liters per day
- remember fluid can be hidden in foods such as fruits and ice cream
- less than a tsp of salt/day
5
Q
Vital to monitor what in fluid retention
A
daily weight.
- same time with same type of clothing every day.
- a weight gain of over 2 kg is 3 days should be reported to the primary care provider
- may be constipated due to use of diuretics; adequate fibre intake is needed
6
Q
What drugs could be used in HF?
A
- ARBS
- Ace inhibitors
- Calcium channel blockers
- Digoxin
- Cardiac glycosides
- Phosphodiesterase inhibitors
- Beta blockers
7
Q
Goals in pharmacologic management of HF
A
- reduction of preload
- reduction of system vascular resistance (reduction of afterload)
- inhibition of RAAS (renin angiotensin aldosterone system) and vasoconstrictor mechanisms of sympathetic nervous system
8
Q
ACE Inhibitors
A
- decrease vascular resistance
- Decrease secretion of aldosterone - less Na+ retention, less fluid retention, less cardiac remodeling
- decrease secretion of ADH
- reduce incidence of MI, protect heart during MI - less fluid retention, decreased thirst
9
Q
ACE inhibitors Adverse effects
A
- adverse effects
- hypotension
- functional renal insufficiency
- angioedema
- dry cough
- hyperkalemia - prevents potassium from being excreted
- ARBs similar to ACE inhibitors however they are not associated with cough and angioedema
10
Q
Angiotesin II Receptor Blockers
- indications
- mechanism of action
- Adverse effects
A
- hypertension, and heart failure, MI, prophylaxis against stroke (CVA)
- blocks angiotensin II from activating their target receptors in smooth muscle - promote vasodilation - decreases BP, afterload, preload - decrease secretion of aldosterone and ADH
- Similar to those of ACE inhibitors though cough and angioedema are much less common
11
Q
Beta1 adrenergic agonists - Dopamine
A
used to increase contractility of heart to produce more powerful contractions but also increase vasoconstriction and cause dysrhythmias including tachycardia
12
Q
Beta blockers
A
- used to decrease heart rate and force of contraction
- some promote vasodilation as well by blocking alpha 1 receptors
- prevent MI and remodeling of ventricles
13
Q
Vasodilators
A
- relax blood vessels - either arterial or venous dilation
- indications (hypertension, heart failure)
- promotes vascular smooth muscle relaxation through a variety of mechanisms
- reduces preload and afterload
14
Q
Cardiac Glycosides
A
- heart failure, can stabilize some dysrhythmias
- positive inotropes (increase contractility) and negative chronotropes (lower the heart rate)
- improve symptoms by decreasing heart rate while increasing force of contraction
- require digitalization to be effective (becomes effective once a suitable concentration of drug has built up in tissues)
- assess apical pulse
15
Q
Digoxin mechanism of action
A
- blocks Na+/K+ ATPase causing Na+ to accumulate in myocytes
- Na+/Ca2+ exchanger is activated bringing Ca2+ into myocytes promoting positive inotropic effect
- Decreases conduction through AV node causing negative chronotropic effect
Digoxin is delaying the electrical impulse so the heartrate is lowed
It also allows calcium to rush in which increases contractility.
