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FA2 Cardiovascular > Lecture 9 9/3/24 > Flashcards

Lecture 9 9/3/24 Flashcards

1
Q

What are the characteristics of afterload reduction?

A

-vasodilators decrease peripheral vascular resistance
-results in an increase in stroke volume
-blood pressure is minimally affected
-easier for sick heart to push blood forward

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2
Q

Which drugs are used as vasodilators?

A

-ACE inhibitors such as enalapril, benazepril, and captopril
-amlodipine

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3
Q

What are the effects of ACE inhibition?

A

-vasodilation
-decreased aldosterone concentrations
-beneficial “neuroendocrine” effects

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4
Q

What are positive inotropes?

A

drugs that increase contractility of the heart

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5
Q

Which drugs are positive inotropes?

A

-digoxin
-dobutamine and other catecholamines
-pimobendan

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6
Q

What are the characteristics of pimobendan?

A

-calcium sensitizing “inodilator”
-phosphodiesterase inhibitor with favorable effects on myocardial energetics

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7
Q

What outcomes have been seen with pimobendan in clinical patients?

A

-decreased mortality in doberman pinschers with stage C DCM
-improved survival relative to ACE inhibition in dogs with stage C MR

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8
Q

What are the characteristics of heart rate in systolic failure therapy?

A

-control of the congestive state indirectly causes heart rate to decrease in most cases
-exception is animals with pathologic tachyarrhythmia

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9
Q

What are the characteristics of spironolactone?

A

-aldosterone antagonist that functions as a weak diuretic
-decreases mortality in people with CHF at a dose that does not affect hemodynamics

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10
Q

Why are the extra-renal effects of spironolactone important?

A

aldosterone antagonist characteristic helps with the supra-physiologic aldosterone conc. seen in heart failure patients; these conc. can contribute to myocardial fibrosis without treatment

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11
Q

What are the characteristics of spironolactone use in dogs?

A

-benefit is uncertain when used with standard treatment such as pimobendan
-use is reasonable when combined with drugs such as benazepril

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12
Q

What are the characteristics of treatment for patients with stage A heart failure?

A

-patients are predisposed to heart failure, but no clinical disease present
-no value to treatment
-important to screen these patients regularly

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13
Q

What are the characteristics of stage B2 mitral valve disease?

A

-grade 3/6 or louder murmur caused by MVD
-VHS > 10.5
-echo. evidence of left atrial and left ventricular enlargement

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14
Q

What is the indicated treatment for stage B2 mitral valve disease?

A

pimobendan

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15
Q

What is the main characteristic of stage B dilated cardiomyopathy?

A

echo. evidence of enlarged end-systolic ventricular dimension

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16
Q

What is the indicated treatment for stage B dilated cardiomyopathy?

A

pimobendan

17
Q

What is the indicated treatment for stage C heart failure?

A

-furosemide
-ACE inhibitor
-pimobendan
-possibly spironolactone

18
Q

What is the indicated treatment for stage D/advanced heart failure?

A

-optimized ACE inhibitor/pimobendan dose
-frequent renal function monitoring
-triple diuretic therapy with furosemide, spironolactone, and hydrochlorothiazide
-additional vasodilation
-hospitalization for parenteral therapy

19
Q

What is cardiorenal syndrome?

A

term used to describe worsening renal function in patients with cardiac disease

20
Q

What are the goals of therapy when treating acute/decompensated heart failure?

A

-decrease venous/filling pressure
-temporary oxygen supplementation
-improve cardiac performance

21
Q

How is acute/decompensated heart failure diagnosed?

A

-thoracic radiographs
-possibly echo.

22
Q

Why is it possible to use BNP measurements in diagnosing heart failure?

A

BNP conc. increase in association with increases in ventricular filling pressures

23
Q

When is it appropriate to treat patients with empirical therapy for suspected heart failure?

A

when risks associated with restraint for diagnostic evaluation exceed the predicted benefit of having answers from the tests

24
Q

What are the general measures taken when treating patients with acute/decompensated heart failure?

A

-supplemental O2
-cage rest
-narcotics or acepromazine to reduce anxiety

25
Q

Why is fluid therapy not indicated in the majority of heart failure patients?

A

-preload is already maximal when CHF is present
-IV fluid administration increases venous pressures

26
Q

Which drugs are indicated in treating acute/decompensated heart failure?

A

-IV furosemide
-oral pimobendan

27
Q

Which monitoring tools/tests should be used when treating a patient with acute/decompensated heart failure?

A

-ECG
-physical exam
-HCT
-total protein
-BUN
-urine output
-body weight

FA2 Cardiovascular (21 decks)

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