Heart Failure

Question 1

Drugs For HF

Answer 1

BB, ACE-I or ARB, diuretic (lessen symptoms but does not increase survival), possibly aldosterone inhibitor, maybe digoxin

Question 2

What two events need to be controlled intraoperatively for HF patients

Answer 2

Myocardial depression and peripheral vasodilation

Etomidate and ketamine help with this (propofol is cardiac depressant)

Question 3

Restrictive Cardiomyopathy

Answer 3

Stiff ventricles that impair ventricular filling

Question 4

Dilated Cardiomyopathy

Answer 4

Large, poor contractile heart with stroke volume preserved by dilation and increased LV end-diastolic volume

Frequent arrhythmias (amiodarone)

Sevo and Iso: cardioprotective

Question 5

Hypertrophic Cardiomyopathy

Answer 5

Outflow tract obstruction produced by septal hypertrophy—> impaired diastolic function (need regular rhythm to ensure enough filling time)

Vasodilators that do not induce tachycardia

Question 6

Inotropes

Answer 6

Beta 1 agonists
Dopamine
Dobutamine
Na/K ATPase inhibition (digoxin)
Increase Calcium
PDE III inhibition (milrinone)—> prevent cAMP breakdown
Glucagon

Question 7

Digoxin MOA

Answer 7

Inhibits Na/K ATPase

Increase NA ions inside prevent exchange of Na outside cell for Ca inside cell causing buildup of Ca in cell, increasing contractility

Question 8

Bad things about Dig

Answer 8

Slow acting (half life is 36 hrs)
Excreted exclusively via kidneys 
Very toxic (therapeutic index is same as toxic level)

Question 9

Hypokalemia and Dig

Answer 9

Increased toxicity with hypokalemia

How much dig binds to receptor is dependent on K

Lower K=higher binding

Question 10

S/S of Dig

Answer 10

GI: N/V/D, cramps

CNS

Visual: colored vision, halo vision

Cardiac: arrhythmias

Question 11

Antidote for Digoxin

Answer 11

Digibind