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sem 5: sam 1 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Define low output heart failure / “Forward” HF

A

ventricular dysfunction resulting in poor tissue perfusion (↓ CO) & arterial hypotension (↓ BP)

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2
Q

Define CHF / “Backwards” HF

A

cardiac malfunction resulting in ↑ pulmonary venous or systemic venous pressures

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3
Q

Which usually precedes the other: low output heart failure or congestive heart failure

A

CHF almost always precedes low output HF

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4
Q

What is the expected blood pressure (High vs Low vs Normal) for the following:

congestive heart failure:
low output heart failure:

A

congestive heart failure: normal BP
low output heart failure: ↓ BP

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5
Q

True or False: patients with CHF usually appear BAR, whereas patients with low output heart failure appear QAR

A

TRUE

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6
Q

BP = _____ X _____

A

BP = CO x SV

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7
Q

List the harmful effects of Angiotensin II

A
  • Free radicals cause cell death and fibrosis resulting in myocardial dysfunction (can’t fill or contract)
  • Increased vasoconstriction causes increased afterload and decreased SV and CO
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8
Q

List the beneficial effects of Angiotensin II

A
  • Increased vasoconstriction and sympathetic tone results in increased BP and increased CO
  • Triggers aldosterone to increase Na+ and H20 which increases blood volume and CO
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9
Q

In concentric hypertrophy, sarcomeres are added in __________

A

parallel

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10
Q

In eccentric hypertrophy, sarcomeres are added in __________

A

series

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11
Q

What symptoms and CS do you expect to see with L-sided CHF?

A
  • Syncope
  • Coughing (Dogs>cats)
  • Hypoxemia (dec. gas exchange from lungs)
  • Exercise intolerance
  • Tachypnea (inc resp rate) to try and compensate/ Dyspnea
  • Pulmonary edema

Cats: pleural effusion causing ABD distention

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12
Q

What symptoms and CS do you expect to see with R-sided CHF?

A
  • ABD and jugular distention
  • Exercise intolerance
  • Cough (Dogs>cats)
  • Tachypnea/Dyspnea
  • Syncope
  • Diarrhea if peritoneal effusion
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13
Q

PE abnormalities in a dog with L-sided CHF?

A
  • Tachypnea/Dyspnea
  • Inc HR (tachycardia)
  • Crackles/wheezes
  • Muscle loss
  • Abnormal heart sounds
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14
Q

PE abnormalities in a dog with R-sided CHF?

A
  • Inc HR (tachycardia)
  • Jug vein distension
  • +/- Tachypnea/Dyspnea if pleural effusion
  • Decreased or absent lung sounds if pleural effusion
  • ABD distension due to peritoneal effusion
  • Abnormal heart sounds
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15
Q

PE abnormalities in a cat with R-sided CHF?

A
  • Inc HR (tachycardia)
  • Jug vein distension
  • Tachypnea/Dyspnea due to pleural effusion
  • Decreased or absent lung sounds due to pleural effusion
  • +/- ABD distension due to peritoneal effusion
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16
Q

PE abnormalities in a cat with L-sided CHF?

A
  • Tachypnea/ +/-Dyspnea
  • Inc HR (tachycardia)
  • Increased bronchovesicular sounds/Crackles/wheezes if pulmonary edema ORRR decreased/absent lung sounds if pleural effusion
  • Muscle loss
  • Abnormal heart sounds
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17
Q

CS and PE abnormalities of Low Output heart failure

A
  • Pale mucous membranes
  • Hypothermia
  • Weak femoral pulses
  • Weakness/collapse
  • Tachycardia (inc HR)
  • Abnormal heart sounds
  • Muscle loss

(Bolded shows differences between low output heart failure vs CHF)

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18
Q

List 2 tests you would want to do in order to diagnoses low output heart failure?

A
  • Blood pressure (will be LOW)
  • Lactate (will be HIGH due to hypoxemia and anaerobic metabolism)
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19
Q

3 Goals of heart failure therapy?

A
  • Relieve congestion
  • Improve cardiac output
  • Prevent progression
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20
Q

The first step of HF therapy is to relieve congestion. How is this done?

A

Decrease ventricular filling pressure by:
- Decreasing blood volume (preload): Give diuretic drug to dec. preload

  • Decrease venous return to the heart (preload): Give venodilating drugs
  • Increase forward flow (CO)
21
Q

Which drug is given during heart failure therapy to decrease preload?

A

Furosemide!!! (loop diuretic)

  • decreases blood volume back to the heart which slows down accumulation and congestion
22
Q

Which drugs is given during heart failure therapy to improve CO and relieve congestion in the case of a systolic dysfunction?

A
  1. Positive inotrope to increase ventricular contractility (Ex: Pimobendan, Dobutamine)
  2. Arterial dilating drugs to decrease afterload
23
Q

Which drug is given during heart failure therapy to improve CO and relieve congestion in the case of a diastolic dysfunction?

A
  1. Negative chronotropic drugs to decrease HR and allow more time for filling
  2. Lusitropic drugs to improve ventricular relaxation and atrial function
24
Q

The 3rd step of HF therapy is to prevent progression/remodeling. How is this done?

A
  • Inhibit the deleterious neuroendocrine mechanisms (Ex: RAAS and Ang II)

Give ACE inhibitor!! Benazepril/Enalapril

25
Q

What is the 1st choice diuretic for CHF in cats and dogs?

A

Furosemide

26
Q

What is the acute/emergency administration dose of Furosemide for a dog with CHF? Cat dose?

A

Dog: 2-4 mg/kg IV or IM
Cat: 1-3 mg/kg IV or IM

27
Q

What is the chronic/maintenance administration dose of Furosemide for a dog with CHF? Cat dose?

A

Dog: Start at 2mg/kg PO BID
Cat: Start at 1 mg/kg PO SID or BID

28
Q

Main electrolyte imbalance seen in a patient on furosemide for CHF?

A

Hypokalemia

29
Q

A patient on furosemide for CHF has developed tolerance. What is an alternate drug you can give?

A

Torsemide (loop diuretic)

  • Better oral bioavailability and longer duration than furosemide
30
Q

How is spironolactone a K+ sparing diuretic?

A

Aldosterone receptor antagonist

  • Blocks Na+ reabsorption and K+ elimination
31
Q

Cardiac effects of ACE inhibitors?

A
  • Combats deleterious effects of chronic RAAS activation
  • Arterial and venous vasodilator
  • Cardioprotective by preventing myocardial fibrosis
32
Q

Contraindications for use of ACE inhibitors?

A

Do not use in dehydrated, hypovolemic, or hypotensive patients

Caution with pre existing renal dz and concurrent NSAID use

33
Q

List conditions that cause renal hypoperfusion

A
  • Hypotension
  • Hypovolemia
  • Dehydration
  • Renal disease
  • Heart failure
34
Q

MOA of nitroglycerin?

A

Venodilator

(decreases preload, used in acute tx of CHF)

35
Q

MOA of nitroprusside and main use?

A

Arteriodilator + venodilator

(decreases afterload via artery dilation)

**Used for severe/life threatening pulmonary edema

36
Q

Sildenafil MOA and main use?

A

Pulmonary arteriodilator

Used for pulmonary hypertension

37
Q

Hydralazine MOA and main use?

A

Arteriodilator (reduces afterload)

38
Q

True or False: Arteriodilating drugs are used in CHF to reduce preload

A

FALSE

Used for CHF but arteriodilators reduce AFTERLOAD

39
Q

True or False: Venodilating drugs are used in CHF to reduce preload

A

TRUE

40
Q

All of the following are arteriodilators used to decrease afterload, except?

A. Nitroprusside
B. Nitroglycerin
C. Amlodipine
D. Hydralazine

A

B. Nitroglycerin (venodilator, decreases preload)

41
Q

List the arteriodilators

A
  1. Nitroprusside
  2. Hydralazine
  3. Amlodipine
  4. Sildenafil (pulmonary arteriodilator)
  5. ACE inhibitors (indirectly)
42
Q

What effects does Pimobendan have that makes it useful in treatment of CHF?

A

Positive inodilator - improves contractility and decreases afterload

43
Q

Main use of digoxin?

A

Weak, positive inotrope used as an anti-arrhythmic

44
Q

Which of the following is NOT a positive inotrope?

A. Pimobendan
B. Amlodipine
C. Dobutamine
D. Digoxin

A

B. Amlodipine (arteriodilator)

  • no effect on contractility, used to dec. BP
45
Q

What would you prescribe to a cat in acute CHF?

A
  • Furosemide
  • Clopidogrel

(same for chronic CHF)

  • +/- pimobendan, vasodilators, etc.
46
Q

What would you prescribe to a dog in acute CHF?

A
  • Furosemide
  • Pimobendan if suspect systolic dysfunction or valvular regurg
  • +/- positive inotrope, vasodilator, etc.
47
Q

What would you prescribe to a dog in chronic CHF?

A
  1. Furosemide (dec. preload and vol to the heart, slows down congestion)
  2. Pimobendan if suspect systolic dysfunction or valvular regurg (increases contractility)
  3. ACE inhibitor (Benazepril/Enalapril) (cardioprotective, indirect vasodilator, counteracts neg effects of RAAS)
  4. Spironolactone (K+ sparing, cardioprotective)
48
Q

Diet reccommendations for a pet in heart failure?

A
  • Adequate calories and protein to prevent cardiac cachexia
  • Omega 3 for anti-inflamm effects
49
Q

List the 2 main cardioprotective drugs that reduce the deleterious effects of RAAS (fibrosis, apoptosis, necrosis)

A
  • ACE inhibitors (Benazepril/Enalapril)
  • Aldosterone antagonist (Spironolactone)

sem 5: sam 1 (26 decks)

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