Hypertension And Heart Disease Flashcards
Pulmonary arterial hypertension (PH) is a progressive and ultimately fatal disease.
What is it and what are causes?
elevated blood pressure in the pulmonary arteries.
PH is a comorbidity of other diseases or conditions, such as: connective tissue diseases, lung diseases, liver disease, pregnancy, HIV infection, left heart failure, usage of the diet medication Fen-Phen.
Symptoms of pulmonary hypertension
non-specific symptoms, such as dyspnea, fatigue, angina, syncope, weakness, abdominal distention. Symptoms at rest only occur in the very advanced stages of PH. left parasternal lift peripheral edema abnormal heart sounds jugular vein distension hepatomegaly ascites cool extremities may be present.
Pharmacological Treatment of pulmonary hypertension
involves using medications to restore the vasodilator effects and prevent overgrowth of cells in an attempt to decrease pulmonary artery (PA) pressures and increase CO.
- Calcium Channel Blockers - nifedipine, amlodipine, diltiazem are used initially if the patient had a positive response to the vasodilator challenge.
- Prostanoids - epoprostenol (Flolan), iloprost (Ventavis), and treprostinil (Remodulin, Tyvaso), may be used in the PH patient who had a positive response to the vasodilator challenge. Epoprostenol is an artificial prostacyclin that mimics prostaglandin, which is a naturally occurring substance in the human body. Acting like prostaglandin, epoprostenol dilates blood vessels, prevents platelets from clumping together, increases CO, and slows the growth of smooth muscle cells.
- Endothelin Receptor Antagonists - bosentan (Tracleer) and ambrisentan (Letairis). Endothelin receptor antagonists vasodilate and prevent cell growth in the arteries by preventing endothelin from activating receptors.
- Phosphodiesterase Inhibitors - Revatio (Sildenafil) and tadalafil (Adcirca), function by inhibiting cGMP-PDE-5. By inhibiting PDE-5, cGMP is not broken down and relaxes the pulmonary blood vessels.
- Combination Therapy - may be used in patients who remain symptomatic on initial medication therapy. Combination therapy has become the standard of care in most PH.
If meds don’t work for pulmonary hypertension, what is next treatment choice?
Lung transplant
What are the purposes of using vasodilators for heart failure?
Vasodilator drugs have been shown to improve survival in HF. The goals of vasodilator therapy in the treatment of HF include
1) increasing venous capacity,
2) improving EF through improved ventricular contraction,
3) slowing the process of ventricular dysfunction,
4) decreasing heart size,
5) avoiding stimulation of the neurohormonal responses initiated by the compensatory mechanisms of HF,
6) enhancing neurohormonal blockade.
Several classes of drugs are vasodilators used with heart failure. What are the they?
.ACE inhibitors (captopril, benazepril, enalapril) are useful in both systolic and diastolic HF. they are the first-line therapy in the treatment of chronic HF.
- Angiotensin II receptor blockers (losartan, valsartan) may be used in patients who are ACE inhibitor intolerant.
- Nitrates are used to treat HF by acting directly on the smooth muscle of the vessel wall. Major effects include a decrease in preload and vasodilation of coronary arteries.
- β-Adrenergic blockers, specifically carvedilol and metoprolol, have improved survival of patients with HF.
- Digitalis glycosides (digoxin) remain the mainstay in the treatment of HF, however, they have not been shown to prolong life.
What is cariogenic shock?
Cardiogenic shock occurs when cardiac output is insufficient to meet the metabolic demands of the
body, resulting in inadequate tissue perfusion. There are four stages of cardiogenic shock; initial, compensatory, progressive, and refractory.
What are the 4 phases of cardiogenic shock? And their descriptions?
- Initial stage, there is diminished cardiac output without any clinical symptoms.
- Compensatory stage, the baroreceptors respond to the decreased cardiac output by stimulating the sympathetic nervous system to release catecholamines to improve myocardial contractility and vasoconstriction, leading to increased venous return and arterial blood pressure. Impaired renal perfusion activates the renin-angiotensin system, whose end product, angiotensin II, causes sodium and water retention as well as vasoconstriction.
- progressive stage follows the compensatory stage if there is no intervention or if the intervention fails to reverse the inadequate tissue perfusion.
- Refractory stage means that it does not respond to treatment.
Causes of cardiogenic shock?
The most common cause of cardiogenic shock is acute myocardial infarction (MI) resulting in a loss more than 40% of the functional myocardium. Cardiogenic shock occurs with 10% to 20% of all hospital admissions for acute MI and carries an 80% mortality rate.
Other causes include papillary muscle rupture, left ventricular free wall rupture, acute ventricular septal defect, severe congestive heart failure, endstage cardiomyopathy, severe valvular dysfunction, acute cardiac tamponade, cardiac contusion, massive pulmonary embolus, or overdose of drugs such as beta blockers or calcium channel blockers.
What are the purposes of cardiac catheterization?
Cardiac catheterization is an invasive procedure that involves passing a catheter through veins and arteries to perform various measurements. It’s used to:
◗ measure heart chamber and pulmonary artery pressures
◗ check blood flow between the heart chambers
◗ detect intracardiac status
◗ determine valve competence
◗ monitor cardiac wall contractility
◗ visualize the coronary arteries.
3 different classes of drugs considered antianginals:
Beta blockers
Calcium channel blockers
Nitrates
Beta adrenerigic blockers
What do they do?
and give some examples of the meds.
Beta blockers
Diminishes sympathetic nervous system response.
Slows heart rate, decreases strength of contraction, lowers BP.
Hypertension, stable angina (CAD), dysrhythmias (example SVT), compensated heart failure, migraines, glaucoma (example: Timolol), tremors, anxiety
◗ Examples: atenolol, metoprolol, nadolol, propranolol
Calcium channel blockers
What do they do?
and give some examples of the meds.
◗ Dilate coronary and peripheral arteries and prevent coronary vasospasm
◗ Used when other drugs fail to prevent angina
◗ Examples: amlodipine, diltiazem, nicardipine, verapamil
Nitrates
What do they do?
and give some examples of the meds.
◗ Produce vasodilation, decrease preload and afterload, and reduce myocardial oxygen consumption
◗ Used primarily to treat angina
◗ Examples: nitroglycerin (Nitro-Bid, Nitrostat, Nitrolingual), isosorbide dinitrate (Isordil)
What are 4 classes of ANTIARRHYTHMICS?
Antiarrhythmics are used to treat disturbances in the normal heart rhythm, and are grouped in one of four classes:
I -sodium channel blockers
II -beta-adrenergic blockers
III -potassium channel blockers
IV -calcium channel blockers
