PCOL (HF-Dyslipidemia) Flashcards
Volume of blood ejected per unit time (L/min)
HR x SV
CARDIAC OUTPUT
Heart Rate is controlled by
Autonomic Nervous System
Volume of blood ejected during systole
Stroke Volume
Intrinsic property of cardiac muscle describing shortening and tension development
Contractility
As myocardial sarcomere length is stretched, the number of cross-bridges between thick and thin myofilaments increases, resulting in an increase in the force contraction
PRELOAD
A more complex physiologic concept that can be viewed pragmatically as the sum of forces preventing active forward ejection of blood of ventricle.
Afterload
Is a measurement of the percentage of blood leaving your heart each time it contracts.
Ejection Fraction
A cardiac disorder that impairs the ability of ventricle to deliver adequate quantities of blood to the metabolizing tissues during normal activity at rest.
Heart Failure
Leads to reduction in muscle mass as a consequence of death of affected myocardial cells
Myocardial Infarction
Progressive disease that is characterized by gradual reduction in cardiac performance, punctuated in many cases by episodes of acute decompensation often requiring hospitalization.
Heart Faiilure
Heart failure is a progressive disorder that begins with ________
myocardial injury
_______ is the classic, more familiar form of the disorder (HF)
HF with impaired systolic function
Retention of salt and water
Edema
Ventricular Hypertrophy and Remodelling
Cardiomegaly
Further increases in preload will only lead to ___________
pulmonary or systemic congestion
_____ will help redistribute blood flow away from nonessential organs to coronary and cerebral circ to support blood pressure
Vasocontriction
Impedes forward ejection of blood from the ventricle, further depressing cardiac output and heightening the compensatory responses
Vasoconstriction
term used to describe an increase in ventricular mass
Ventricular Hypertrophy
Inc in ventricular wall thickness without chamber enlargement
Concentric Hypertrophy
Myocyte lengthening with increased chamber size with minimal increase in wall thickness
Eccentric Left Ventricular Hypertrophy
Broader term describing changes in both myocardial cells extracellualr matrix that result in changes in the size, shape, structure, and fx of the heart
Cardiac or Ventricular Remodeling
This model recognizes that there is an initiating event that leads to decreased CO and begins the “heart failure state”
Neurohormonal Model
this hormone is synthesized directly in the myocardium through non-ACE dependent pathways
Angiotensin II
Play a central role in tachycardia, vasoconstriction, and increased contractility observed in HF
Norepinephrine
sodium retention and its key role in volume overload and edema has long been recognized as impt component of the HF syndrome
Aldosterone
Primary manifestations of HR
Dyspnea and Fatigue
most common type of HF
-metab demands are within normal limits but heart cant meet them
LOW OUTPUT FAILURE
Form of HF with Inc metab demands
px with pathologic conditions
HIGH OUTPUT FAILURE
Blood cannot be adeq pumped from the left ventricle to the peripheral circ and it accumulates within left ventricle
LEFT-SIDED FAILURE
form of HF when blood cannot be pumped from the right ventricle into the lungs and accumulates within and right ventricle
RIGHT-SIDED FAILURE
When fluid collects in the lungs interferes with breathing
Pulmonary Edema
(Digitalis)
Better PCOL Profile
Digoxin (D. Lanata)
(Digitalis)
Most toxic
Digitoxin (D. Purpurea)
(Digitalis)
Most imp, poorly soluble
Quabain
Used in emergency tx of px with HF and in px refractory to or unable to take digitalis
Inotropic Agents
(Inotropic Agents)
acts on D1
acts on B1
Dopamine
Dobutamine
(Inotropic Agents)
PDE inh, refractory to other inotropic agent
Inamrinone
(Inotropic Agents)
PDE inh for acute/chronic HF, cause hepatotoxicity so required monitoring
Milrinone
Newer class of drugs that inh both ACE and neutral endopeptidases, an enzyme that inactivates bradykinin and natriuretic peptide
Omapatrilat
Death of myocardial cells from inadequate oxygenation, often caused by a sudden complete blockage of a coronary artery
Myocardial Infarction
Primary cardiac marker
CK-MB
More specific and sensitive than CK-MB
Troponin T and I
treatment for patients with coronary artery disease
Percutaneous Transluminal Coronary Angioplasty (PTCA)
CABG meaning
Coronary Artery Bypass Graft (CABG)
__________Most common form of Dyslipidemia
aka______
Hyperlipidemia
Hyperlipoprotinemia
(Dyslipidemia)
Inc cholesterol = atherosclerosis plaque
Hypercholesterolemia
(Dyslipidemia)
Inc Triglyceride
Hypertriglyceridemia
(Dyslipidemia)
Estimation of total CV risk
Framingham, SCORE
(Dyslipidemia)
-Blocks formation of mevelonic acid
-Most effective in Hypercholesterolemia
-Commonly admin at night
HMG-COA Reductase Inh
(HMG-COA)
-most BA
-impaired by food
-most effective
-Fluvastatin (Loscol)
-Pravastatin (Zocor)
-Rosuvastatin (Crestor)
used in TX of px with primary hypercholesterolemia
Bile-Acid Binding Resins
Niacin
Precursor:
Deficiency:
ADR:
-Tryptophan
-Pelagra
-Flushing
First member of a group of drugs that inhibit intestinal absorption of phytosterols and cholesterol
Ezetimibe
(Dyslipidemia)
Plant steroid (phytosterol)
Beta-Sitosterin
Arrest of blood loss from damaged vessels and is essential for survival
Hemostasis
Platelet plug
White thrombus
Temporary Barrier
White Thrombus (WBC)
Primary Hemostatis
Permanent Barrier
Red Thrombus (RBC)
Secondary Hemostatis
Factors involved in Intrinsic Pathway
Factors 12, 11, 9, 8
Factors involved in Extrinsic Pathway
Factor 7
Convert fibrinogen to fibrin
Thrombin
A transaminase that cross-links the fibrin polymer and stabilizes the clot
Factor 13
is an endogenous anticoagulant and member of serine protease inh (serpin) family
Antithrombin (AT)
Most common defect in natural anticoagulant system
Mutation in Factor V to V leiden
fibrin-specific protease
plasmin
DOC for anticoagulant when pregnant
Heparin
effects similar to LMW heparin
Fondaparinux
