heart failure Flashcards
collapse- (muscle + pump)
- Heart gives out –
- -Can’t keep up with the demands of the body/
- -Not pumping enough
- _____ increases
- _____ backs up in the system
inside pressure
fluid
CARDIAC OUTPUT= STROKE VOLUME × HEART RATE
- SV depends on _____, _____ and _____
- HR depends on _____ and _____ tone
preload afterload contractility parasympathetic sympathetic
Where does the blood BACK-UP?
- Preload is _____
- Afterload is _____
high
high
LOW CARDIAC OUTPUT –HORMONAL REACTION OF THE BODY?
- _____/_____?
- _____?
- Effect of Epinephrine on _____, _____ and _____
- Name the receptors
- Effect of RAAS on Preload
- Stress on the heart?
epinephrine norepinephrine RAAS afterload contractility heart rate
CHRONIC HEART FAILURE
-_____ – Pt is stable, fluid retention & pulmonary edema are absent
- _____ – Pt deteriorates, may present as acute episode of _____ or as lethargy and malaise
- A reduction in _____ tolerance and increasing _____ on exertion
compensated DECOMPENSATED pulmonary edema exercise breathlessness
- Back-up in Veins of Lungs (_____ sided heart failure)
- -_____ edema (_____) and Shortness of breath
- Back-up in Veins of Feet and Lower Legs (_____ sided heart failure) and later in the _____
- -Swelling and Ascites
-_____, Anxiety, _____
Left Pulmonary pleural effusion Right Abdomen Tiredness palpitations
diagnosis
- _____ (test of choice)- determines ejection fraction
- Chest X ray
- _____
- _____ (polypeptide secreted by heart in response to excessive stretching of myocytes) almost always elevated in _____ HF
- Normal BNP excludes CHF as a cause of _____
Echocardiography Electrocardiogram Brain Natriuretic peptide decompensated dyspnea
management of heart failure
- NON-PHARMACOLOGIC –
- Reduction of _____ intake
- PHARMACOLOGIC –
- -Drugs that lower mortality
- -_____/_____
- -_____ blockers
- -_____ (or Eplerenone)
- -_____ and Isosorbide nitrate
- Drugs that decrease symptoms but do not lower mortality
- -_____
- -_____
salt ACE ARB Beta Spironolactone Hydralazine Digoxin diuretics
ACE INHIBITORS /ARBS
ACE inhibitors –
-Recommended for all patients irrespective of _____ status, reduce _____ and _____ through _____
ARBs –
-Are acceptable alternatives in those unable to tolerate ACE inhibitors (cough, angioedema), block _____(AT1) _____
blood pressure pre-load after-load vasodilation type 1 angiotensin II receptors
BETA BLOCKERS – _____, _____
-Chronic adrenergic activation
-Decrease _____, reduce hospitalizations and improve functional class
-If beta blockers decrease heart rate and contractility, then don’t they also decrease cardiac output?
Wouldn’t that make CHF worse since it is a state of low CO?
CARVEDILOL
METOPROLOL
mortality
DIURETICS
- DOC for acute _____ edema symptoms
- Most commonly used is LOOP diuretic (_____)
- Thiazides (_____) useful in mild HF
- Aldosterone antagonists ( _____ and _____) is add on therapy to _____
pulmonary Furosemide Hydrochlorothiazide Spironolactone Eplerenone ACE inhibitors
How about if we give the donkey some incentive to work harder?
- Two types of drugs can increase the cardiac output
- _____
- _____ (Dobutamine and Milirinone)
Digoxin
Sympathomimetics
CARDIAC GLYCOSIDES – DIGITALIS
- Positive _____ (HF) & Negative _____ (AF)
- Improves symptoms
- Improves QOF
- Reduces hospitalizations but does not improve _____
- Inhibits _____ resulting in increased intracellular concentration of Na+ and decreased exchanges of intracellular _____
- Increase intracellular Ca2+ improves cardiac _____ (ie force and velocity)- promoting ventricular emptying
- _____ and _____ compete for myocardium binding sites
- _____ will decrease digitalis activity and _____ will result in toxicity
Inotropic Chronotropic survival Na+/K+- ATPase pump Ca2+ contractility K+ Digitalis Hyperkalemia hypokalemia
DIGITALIS – USES
- _____
- _____/flutter
- _____ (SVT)
CHF
Atrial fibrillation
Paroxysmal atrial tachycardia
TOXIC EFFECTS OF DIGITALIS
- _____ and Vomiting
- _____
- _____
- _____ halo around objects
- _____ (tachy or brady)
- MANAGEMENT – _____ (Digoxin-specificantibody(Fab) fragments)
Nausea gynecomastia blurred vision Yellow Arrhythmias Digibind