Heart Failure and Shock Flashcards
What is cicrulovasculatory shock?
Acute, life threatening condition associated w/ insufficient blood delivery to tissues
What are the types of circ shock?
- Hypovolemic Shock
- Distributive Shock
- Cardiogenic Shock
What is Hypovolemic shock?
Shock from blood loss
What is the tx of hypovolemic shock?
Transfusions/fluid replacement + vasoconstrictors
Restore BP through vasoconstriction while sustaining BF through key organs
What is used to tx hypovolemic shock?
Alpha 1 Receptor Agonist w/ DA and/or Beta2 agonist effects
What is distributive shock?
Intesnse vasodilation due to infection (septic shock), allergic rxn (anaphylactic shock), or brain/spinal cord injury (neurogenic shock)
Tx for distributive shock?
Manage primary cause + Vasoconstrictors
What is cardiogenic shock?
Stoppage of the heart, HF
Causes of Acute HF? (4)
- Acute MI
- Cardiac Arrhythmias
- Valve Issues
- End Stage Chronic HF
Treatment of Acute HF?
Positive ionotropic agents
What classes of drugs are used to treat cardiogenic shock?
BETA 1 RECEPTOR AGONISTS
- Beta 1 adrenergic receptor agonist
- Phosphodiesterase 3 Inhibitors
- Muscarinic Rec Antagonist
What is the beta-1 adrenergic receptor agonist drug used to treat cardiogenic shock?
Dobutamine
What is the PDE3 inhibitor used to treat cardiogenic shock?
Milrinone
What is the Musc Rec Antagonist used to treat Cardiogenic Shock and what does it do?
Atropine, block effects of the PSNS on heart
What is chronic/congestive HF and what are the causes?
Cardiac output is insufficient to meet the O2 demands of the body
- Coronary Artery Disease/MI
- HTN from cardiac hypertrophy
* Valve disease/cardiomyopathy/congenital defects/endocarditis
What are the left ventricular symptoms of systolic HF?
- Pulmonary Edema
2. Enlarged heart = accumulation of blood in the ventricals
What is the right vent symptom of systolic HF?
Pitting Edema of the lower limbs = backup of blood w/ venous circulation
Signs and Symptoms of HF (7)
- Skin cyanotic and clammy
- Anxiety/restlessness
- Upright posture/forward leaning
- Persistent cough
- Rapid Breathing
- Fast HR
- Edema of lower limbs
What is the goal for tx of Chronic HF?
Increase CO
What are the determinants of CO? (4)
- Contractility
- HR
- Afterload
- Preload
What is contractility regulated by?
SNS - Beta1 receptors
Calcium Dependent
What is HR regulated by?
SNS - Beta 1
*Increasing HR in congestive HF is counterproductive
What is afterload regulated by?
SNS - Alpha 1
Renin-Angiotensin System (angiotensin II)
What is preload regulated by?
Return of blood to heart = veins BV - kidneys Angiotensin system (Angiotensin II)
With increased preload, there is _____ CO.
Decreased
Viscious Cycle of HF
- Decreased CO from dysfunction
- Compensatory Responses : Baroreceptors and RAS
- Increased Cardiac Work from Increased TPR and BV
- Myocardial Hypertrophy
General Therpeutic Goals of HF (2)
- Reducing symptoms and slowing disease progression during periods of stable HF
- Managing episodes of acute failure
Specific Therpeutic Goals of HF (3)
- Improve mycardial contractility w/o increasing HR
- Reduce Afterload
- Reduce Preload
Steps in treatment of CHF (3)
- Reduce workload of the heart: activity, bp, weight
- Reduce Sodium: diet
- Pharmacotherapy: multiple drugs
Drugs to treat CHF (5)
- Ace Inhibitors/Angiotensin Receptor Blockers
- Beta Blockers
- Diuretics
- Vasodilators (NOT CCB)
- Cardiac Glycosides
First line of drug class for CHF?
ACE Inhibitors + Diuretics
Reduce symptoms and Mortality
*-prils
Therapeutic Effects of ACE inhibotrs (4)
- Relaxation of Arterial Smooth Muscle (reduce afterload)
- Reduce Aldosterone Production (reduce sodium reab and BV)
- Dilate Veins (?)
- Reduce Trophic Changes in the Myocardium (prevents remodeling)
What is used when ACEi are poorly tolerated?
ARBs
Efficacy of ARBs for treatment of CHF?
Debateable
What ARBs are used to treat CHF?
Valsartan and Candesartan
How do Beta Blockers help treat CHF?
Reduce CO but Improve survival
*used w/ ACEi or ARB
What Beta blockers are used for CHF?
- Bisoprolol
- Carvedilol
- Metoprolol
* others are not effective
* combine w/ ACEi
How to administer beta blockers for CHF?
- Initially slowly at low doses
2. Cautiously increase
Which Beta Blockers are cardioselective?
Bisoprolol and Metoprolol
Which Beta blocker is also an alpha1 antagonist?
Carvedilol
What can be added to ACE inhibitors to reduce morbidity and mortality compared to ACEi alone?
Spironalactone, eplerenone
What is an SE of using aldosterone antagonists like spironalactone?
Blocks receptors for sex hormones
What cases are the classes of Diuretics used for when added to ACE inhibitors for CHF?
- Aldosterone blocking k sparing agents = first line tx
- Thiazides = mild failure
- Loop Diuretics: more sever cases
How do vasodilators treat CHF? Other things to know too (2)
- Venous Dilators = nitrates - decrease preload
- Arterial Dilators = hydralazine - decrease afterload
* Given in combo
* Not 1st line tx
Can you switch from digitalis glycosides to ace inhibitors?
Not w/o deterioration
What drugs are (digitalis) glycosides?
- Digoxin
2. Digitoxin
What are the beneficial effects of glycosides?
Increase Cardiac output by increasing myocardial contractility as a result of effects on Calsium
Facts about glycoside effects (4)
- Reduce congestive symptoms and improved exercise tolerance
- Reduce lethality from progressive damage - increases sudden death
- Low margin of safety
- Treat OD w/ digitalis antibodies
How do cardiac glycosides work? (2)
- Prevent transport of Na into cells by Na/K pump (compete w/ K for site)
- Increase Intracellular Na = more Ca intracellularly = more force of contraction