Heart Failure and Cardiomyopathies Flashcards
resistance heart must overcome to push blood out; McDonald’s straw vs a coffee stirring straw
afterload
amount of myocardial elasticity
contractility
filling pressure of the heart, the more the fill and stretch, the harder the subsequent contraction; think preparatory dip
preload
net equilibrium between filtration and reabsorption
Starling’s law of capillaries
name three drug classes that decrease HR, thus decreasing CO
- Beta-blockers
- CCBs
3 Digoxin
Name three factors that decrease HR
- PNS (vagal stim)
- conduction abnormalities
- Drug effects
Name three drugs that increase HR
- Caffeine
- Cocaine
- Other sympathomimetics
Name three factors that increase HR
- SNS stimulation
- Hypovolemia
- Drug effects
Name the 7 factors the decrease preload, thus decreasing stroke volume
- hypovolemia
- excessive vasodilation
- increased intrathoracic pressure
- cardiac tamponade
- RV infarction/failure
- Tachyarrhythmias
- Loss of atrial “kick”
Name three factors that increase preload, thus increasing stroke volume
- heart failure
- hypervolemia
- bradydysrhythmias
resistance the heart must overcome to push blood out; McDonald’s straw vs coffee stirring straw
Afterload
Name the four drug classes that decrease afterload (McDonald’s straw)
- CCB
- Nitrates
- Alpha blockers
- Vasodilators
Why do calcium channel blockers decrease afterload
by causing vasodilation of the arterial vascular beds; make the straw bigger
Why do nitrates decrease afterload and preload?
dilate vascular smooth muscle, coronary vessels, and peripheral veins, all which lower myocardial oxygen consumption; make the straw bigger
Why do Alpha-blockers decrease afterload?
vasodilate blood vessels; make the straw bigger
Why do beta-blockers decrease HR?
inhibit beta 1 receptors, which affect the heart rate
Why do calcium channel blockers decrease HR?
prevent Ca2+ from entering the myocardial cells = decreases muscle contraction and force
Why does digoxin decrease HR?
reduces the # of electrical impulses that pass through the AV node
Name five factors that increase afterload, thus decreasing SV; coffee stirring straw
- vasoconstriction from SNS or vasopressin
- hypertension
- aortic valve stenosis
- hypercoagulability
- Pulmonary hypertension
amount of myocardial elasticity
contractility
Name 4 drug classes that decrease contractility
- beta-blockers
- anesthetics
- Barbiturates
- Most antiarrhythmic meds
Why do beta-blockers decrease contractility, thus decreasing SV?
prevent stimulation of beta 1 = decrease HR and contraction force
Name 5 factors that decrease contractility
- myocardial ischemia/infarction
- Cardiomyopathies
- Hypoxemia
- Acidosis
- Drug effects
Name 2 factors that increase contractility
- SNS stimulation
2. Sympathomimetic drugs
Name 2 causes of lymphatic obstruction/lymphadema
- Following modified radical mastectomy and radiation
2. Filariasis (Wuchereria bancrofti)
Osmotic pressure is reliant on the amount of _____
Albumin + other large plasma proteins
What happen to osmotic pressure if there isn’t enough albumin?
decreases
what are the clinical presentations for Left-sided forward systolic dysfunction
fatigue, oliguria, increased HR, faint pulses, restlessness, confusion, anxiety
What are the clinical presentations for left-sided backward systolic dysfunction?
Dyspnea on exertion, orthopnea, cough, postural nocturnal dyspnea, cyanosis, basilar crackles
What is the typical cause of right sided heart failure?
Left sided heart failure
What are the typical causes of left sided heart failure?
CAD and hypertension
What are the clinical presentations for right sided forward systolic dysfunction?
fatigue, oliguria, increased HR, faint pulses, restlessness, confusion, anxiety
What are the clinical presentations for right sided backward systolic dysfunction
hepatomegaly, ascites, spenomegaly, anorexia, subcutaneous (peripheral) edema, jugular vein distention (JVD)
What labs would you order in a patient you suspect may have HF?
CBC, Electrolyte, BUN, creatinine, Liver function, Calcium, magnesium, phosphate, Thyroid, BNP
No limitations and asymptomatic during usual activity
New York Heart Assoc Class I
slight limitations and mild symptoms (dyspnea, fatigue, or chest pain) w/ ordinary activities
NY Heart Assoc Class II
Moderate limitations w/ symptoms noted with minimal activity
NY Heart Assoc Class III
Severe limitations w/ symptoms at rest
NY Heart Assoc. Class IV
What should you use to immediately treat the symptoms of HF?
Diuretics
What’s the first line drug choice for immediate treatment of HF?
ACE-Is
What can be combined with ACE-Is for immediate treatment of HF?
Beta-blockers
What is/are your 1st line drug class choice for long term management of HF?
ACE-Is (1st; “-prils”; lisinopril); ARBs (1st-ish; “-artans”; losartan)
What is your second line drug class choice for long term management of HF?
Beta-Blockers (“-olol”; metoprolol, and -ilol”; carvedilol)
What is your first line drug choice for the long term management of HF in black patients?
Hydralazine + nitrates
Pulsus bisferiens should make you think of which type of cardiomyopathy?
Hypertrophic cardiomyopathy
Pulsus parvus et tarsus is associated with what type of murmur?
Aortic stenosis
Pulses paradoxus is characterized by:
decrease of at least 20 mm Hg in systolic blood pressure during inspiration. It is seen in both cardiac and respiratory pathologies, including cardiac tamponade, chronic obstructive pulmonary disease, and severe asthma.
Austin Flint murmur (A) is a low-pitched diastolic rumble best heard at the cardiac apex and is associated with what type of murmur/ valvular disease?
Aortic regurgitation
