Heart failure Flashcards
what is heart failure
abnormality of cardiac structure or function leading to failure of the heart to deliver oxygen at a rate that fulfills the requirements of tissues in the body
how do you calculate the ejection fraction of the heart
amount of blood pumped out of the ventricle divided by the total amount of blood in the ventricle
what ejection fraction is considered heart failure
50%
how do cardiomyocytes resspond to an action potential
depolarization of the membrane then shortens the contractile proteins then relaxes to return to resting state
what is echocardiography
send soundwaves into the body which are reflected at the interfaces between tissue, the return time tells the depth of the reflecting surface
what is the force of muscle contraction related to
amount of cytosolic calcium
what causes the initiation of the contractile process
calcoium enters from outside the cell which triggers release from the sarcoplasmic reticulum and mitochondria stores
how is muscle relaxtion achieved after the release of calcium
removal of free calcium by Na/Ca exchangers and reuptake into SR and mitochondria
why is heart failure initially not perceived by the patient
compensatory mechanisms
3 ways the body tries to correct failure
increase sodium retention
activate RAAS (angiotensin, aldosterone)
sympathetic nerve activation
how does increased sodium retention increase BP
increases blood volume slowly
how does activating RAAS increase BP
angiotensin constricts arteries and veins
aldosterone causes sodium retention
how does activating SNS increase BP
increase heart rate
increase contractility
what happens as a result of overly increased plasma volume and constriction of veins due to compensatory mechanisms
venous return stretches the already overstretched ventricles
heart cant increase force of contraction
heart enlarges and thickens
venous presure increases causing edema
what happens as a result of overly increased constriction of arteries dur to compensatory mechanisms
increased TPR heard for heart to empty against
increased resistance to outflow more than heart can overcome
result of cardiac overstimulation due to compensatory mechanisms
down regulation of beta receptors, increased fibrosis and apoptosis
what happens in left sided heart failure
blood backs up into lungs and periphery causing pulmonary edema which can be life threatening
what happens in right sided failure
blood backs up into periphery causing peripheral edema
main signs and symptoms of heart failure
edema, cough and dyspnea (difficulty breathing)
with each acute event, myocardial injury may contribute to what
progressive LV dysfunction
two examples of inhibitors of the RAAS
ACEI = enalapril ARB = losartan
two examples of beta blockers
metoprolol
carvediol
two examples of inotropes
digoxin
dobutamine
5 examples of diuretics
furosemide
metolazone
aldosterone antagonist
spironolactone
why are ACE inhibitors used in heart failure
vasoconstriction and blood volume retention from the RAAS become a problem and these reduce that
first line in heart failure because it slows the course and decreases mortality
ACE inhibitor
can ACE inhibitors be used in pregnancy
no causes birth defect
side effects of ACE inhibitors
hyperkalemia
dry cough
do ACE inhibitors effect lipids or blood glucose
no metabolically neutral
what other drugs cant be used with enalipril because they increase potassium levels
ibuprofen, indomethacin
losartan
alka-seltzer
trimethoprim
how is losartan different from enalipril
doesnt increase bradykinin or cause of cough
