Heart Failure Flashcards
index for preload
End diastolic volume (influenced by chamber compliance
HF with reduced ejection fraction is due to ___ dysfunction
systolic
cor pulmonale
right sided failure that results from primary pulmonary process
right sided failure is suceptible to failure with sudden _____
increase in afterload
right sided heart failure, RV has ___ compliance
high
2 mechanisms of compensation for heart failure
frank starling increase in VEDV
hypertorphy
negative consequences of renin-angiotensin activation
increase in afterload and fluid retention
sympathetic stim increases ___ to maintain organ perfusion
vasoconstriction
presentation symptoms of left sided failure
dyspenea
orthopnea
paroxysmal nocturnal pyspnea
fatigue
physical exam left sided failure
diaphoresis
tachy
pulmonary rales
loud P2 (s3 gallop in systolic dsfxn, s4 for diastolic)
presentation right sided failure
peripheral edma
right upper quadrant discomfort (liver enlargement)
physical exam right sided failure
jugular venous distention
hepatomegaly
peripheral edema
Digoxin therapuetic effects
positive ionotrope
increases vagal tone to slow HR
arterial and venous dilation
normalized baroreceptors
mechanism digoxin
inhibition of NaK ATPase - results in less drive to push Na out of Cell
results in increased levels of Ca in cells > contractility
ECG finding of Digoxin use
increased PR interval (decreasted conduction velocity in AV node, reduced firing of SA node)
pharmacokinetic digoxin
36 hour half life
oral
kidney excretion
adverse effects Digoxin
GI,
Visual disturbances
Neuro - disorientation, hallucinations
Muscular weakness and fatigue
cardiac arrhythmias
hypokalemia
indications DIgoxin
not first line
LV systolic dsfxn with AFib,
refactory pts in sinus rhythm
indications B adrenergic agonists (dopamine dobutamine)
IV hemodynamic support for acutely ill (acute decompensated HF)
indications phosphodiesterase inhibitors (milrinone)
limit IV for acute (decompensated HF)
positive inotrope and vasodilator
therapuetic effects diuretics
reduce fluid volume > preload
reduced heart size
reduced edema
loop diuretic, promotes K loss > hypokalemia
furosemide
thiazide diuretic, in combo with loop diuertics, promotes k loss (hypokalemia)
clorothiazide
weak diuretic activity, limited K and Mg wasting.
K sparing
amiloride, triamterene
atrial dilator
hydralazine
arterial vasodilator hydralazien therapuetic effect
reduced systemic resistance > increased stroke volume
___ stimulates fibrosis in heart and vasculature,
cardiac hypertrophy
aldosterone
promotes sympathetic activation by increasing adreal medullary catecholamien release
angiotensin
promotes myocardial hypertrophy and apoptosis
angiotensin
ace inhibitors
Captopil
lisinopril
enalapril
actions in heart failure, ACE inhibitors
Decrease systemic vascular resistenace (afterload)
reduce preload
reduce Na retention, cardiac fibrosis, hypertrohpy
ACE Inhibitors may decrease ___ function, particularly in HF patients
renal function
with ACE inhibitors, ___ may develop, esp if used with aldosterone angtonist
hyperkalemia
angiotensin R1 blocker
Losarton
indications, losartan
alternative to ACE inhibitors
(avoids problematic side effects by not impacting bradykinin)
ACE inhibitor Adverse effects
Hyperkalemia
angioedema
hypotension
dry cough
angioedema, dry cough, and other side effects of ACE inhibitors due to
reduction of bradykinin breakdown
veno dilator and arterial dilator combination
isosorbide dinatrate and hydralzine
aldosterone antagonists
spironolactone, eplerenone
therapeutic effects spironolactone, eplerenone
reduced edema (renal effects)
decrease fibrosis in myocardium and vessels_
therapeutic effects Beta blockers
decrease arrythmias
decrease O demand,
decrease BP
prevent disease progression
proven effective B blockers
carvedilol, metoprolol, bisoprolol
Furosemide
Improve symptoms?
Decrease mortality?
Prevent CHF?
Neurohormonal Control?
yes
?
?
?
digoxin
Improve symptoms?
Decrease mortality?
Prevent CHF?
Neurohormonal Control?
yes
no
minimal
yes
inotropes
Improve symptoms?
Decrease mortality?
Prevent CHF?
Neurohormonal Control?
yes
increase mortality
?
no
beta blockers
Improve symptoms?
Decrease mortality?
Prevent CHF?
Neurohormonal Control?
yes
yes
yes
yes
ACE inhibitors
Improve symptoms?
Decrease mortality?
Prevent CHF?
Neurohormonal Control?
yes
yes
yes
yes
spironolactone
Improve symptoms?
Decrease mortality?
Prevent CHF?
Neurohormonal Control?
yes
yes
yes
yes
