Heart Failure Flashcards
CARDIAC OUTPUT= ______ × ______
- SV depends on _____, _____ and _____
- HR depends on _____ and _____ tone
afterload is increased bc of _______
preload increased because of ______
stroke volume, heart rate preload afterload contractility parasympathetic sympathetic angiotensin II aldosterone
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
DOBUTAMINE
(a synthetic catecholamine)
-Pure _____; β1 > β2 > α receptor agonist
-Increase _____
MILRINONE
- _____ inhibitor
- Increase _____
-Chronic heart failure patients awaiting heart transplants are candidates for_____ support until the donor heart becomes available
adrenergic intracellular Ca+ PDE intracellular Ca+ intravenous inotropic
DIGOXIN – DRUG INTERACTIONS
- _____ disturbances (_____, _____, and _____) lead to increased sensitivity to digoxin making toxicity more likely even with a lower concentration of serum digoxin
- Drugs that decrease clearance of digoxin – _____ and _____
electrolyte hypomagnesemia hypercalcemia hypokalemia Macrolides Antifungals
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
DIGITALIS – USES
- _____
- atrial _______/_____
- _____ (SVT)
CHF
fibrillation/flutter
Paroxysmal atrial tachycardia
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
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
DIGITALIS TOXICITY
- Conditions predisposing to digitalis toxicity:-
- _____ insufficiency
- _____ disturbances (Hypokalemia, Hypercalcemia, Hypomagnesemia)
- Advanced age
- _____ defects ( sinoatrial & AV block)
- Thyroid disease, especially _____
Renal
electrolyte
conduction
hypothyroidism
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 type 1_____(___) receptors
blood pressure pre-load after-load vasodilation type 1 angiotensin II AT1 receptors
________ – initially the preload increases, if there is volume overload initially the stroke volume will keep on building up
But after some time this will not occur, stroke volume will go down, heart is starting to fail
_______ – with increase in afterload, stroke volume starts to go down, the vital organs are not getting enough blood, epinephrine is released constricted vessels
starling mechanism
force tension
DOBUTAMINE AND MILRINONE
- _____, for a few days in advanced heart failure
- ++ Sympathetic nervous system including _____ receptors
- This increases heart rate and contractility = _____
- Symptoms improve
- ???Sympathetic ++ was bad in a pathologically diseased heart and will make things worse
- _____ - long term
- _____ term – they relieve symptoms
IV Beta INCREASED CO yes it will Short
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
TOXIC EFFECTS OF DIGITALIS
- _____ and Vomiting
- _____
- _____
- _____ halo around objects
- _____ (tachy or brady)
- MANAGEMENT – _____ (Digoxin-specific antibody (Fab) fragments)
Nausea gynecomastia blurred vision Yellow Arrhythmias Digibind
- Back-up in Veins of Lungs (_____ sided heart failure)
- -_____ edema (_____) and ____
- Back-up in Veins of Feet and Lower Legs (_____ sided heart failure) and later in the _____
- -Swelling and Ascites
-_____, Anxiety, _____
Left Pulmonary pleural effusion SOB Right Abdomen Tiredness palpitations
DIGOXIN – PHARMACOKINETICS
- _____ bioavailability 70%
- PPB 20-30%
- Vd 400L
- Elimination t1/2 _____ Hrs (Loading dose & Once daily dosing)
- Excreted unchanged by _____
- Therapeutic index is very _____ (TDM)
- Severe toxic effects, such as cardiac _____ may occur at plasma concentrations only _____ the therapeutic plasma concentration range
Oral 40 kidneys narrow arrhythmias twice
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
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
left sided HF causes: -\_\_\_\_\_\_\_\_\_ disease -system \_\_\_\_\_\_\_ -\_\_\_\_\_\_\_ heart disease -\_\_\_\_\_\_\_\_\_\_\_\_\_
effects:
- pulmonary _______
- pulmonary ______
- -decreased __________
-progressive ______ of blood
- decreased ___________
- -decreased tissue _____
- -decreased ________ capacity
coronary artery hypertension valvular dilated cardiomyopathy congestion edema oxygenation backup ejection fraction perfusion extertional
Where does the blood BACK-UP?
- Preload is _____
- Afterload is _____
Classification of heart failure depends on the stage of heart failure
______ – time when heart is filling, depends on venous return
_____– time when the heart is completely full of blood
_______ – the heart contracts and the amount of blood that Goes out depends on afterload
____ – amount of blood left in the heart after systole
A normal functioning heart has ESV, there is always some blood left over
Ejection fraction – amount of blood that is released from heart from the total blood that was originally there after the end of diastole
high high diastole EDV systole ESV
right sided HF causes: -persistant \_\_\_\_\_\_\_ failure -\_\_\_\_\_\_\_ heart disease -severe \_\_\_\_\_\_\_\_ disease such as emphysema
effects:
- ________ in organ systems (liver, GI tract)
- peripheral _______ of extremities (ankles, legs)
left-sided failrue valvular pulmonary congestion edema
ASPIRIN USE IN CHRONIC HEART FAILURE
- Is Aspirin beneficial in CHF patients?
- Is Aspirin potentially harmful in HF patients?
- Is it reasonable to expect aspirin would be beneficial in CHF patient with underlying CAD?
- Other safer options – Anticoagulant (_____) /Antiplatelet (_____, _____)
Warfarin
Clopidogrel
Ticagrelor
