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21 Cards in this Set
- Front
- Back
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what are the 4 major causes of CHF?
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1) HTN
2) weight 3) diabetes 4) LVH |
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biochemically how do beta agonists increase ionotopic force of the heart? who breaks down cAMP?
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- stimulate adenylate cyclase --> increased cAMP --> opens Ca channel
- PDE breaks down cAMP so PDEi can also act as ionotropic agents |
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what is Fick's principle?
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- inject room temperature saline into catheter (swan ganz" then look at changes in temperature to measure CO
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what is the difference between relaxation & passive compliance in diastolic performance?
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- relaxation: energy dependent, get calcium out
- passive compliance: ventricular properly related to myocardial stretch, effected by extrinsic structures (pericardium) & intrinsic |
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what is systolic vs diastolic heart failure?
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- systolic due to impaired contractility or increased after load (decreased EF)
- diastolic due to impaired ventricular filling, relaxation, compliance (normal EF) |
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what kind of HF does dilation vs hypertrophy cause?
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- dilation causes systolic
- hypertrophy causes diastolic |
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what are causes of RHF?
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- LHF, cor pulmonale, tricuspid valve disease
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when do you see eccentric hypertrophy?
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- after MI
- concentric is a pressure overload (HTN, metabolic syndrome, AS) |
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why can hypertrophy be bad?
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- alteration in contractile proteins & Ca handeling
- transition from hypertrophy to failure (altered contractile & relaxation) - apoptosis, fibrosis |
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what hormones vasoconstrict during heart failure? what hormones vasodilate?
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- RAS, vasopressin, endothelin --> also promote Na & water retention
- natriuretic peptides |
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what is BNP an indicator of?
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- secreted by ventricular myocardium, goes up in HF
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what are the symptoms of HF?
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- low CO, fatigue, exertional dyspnea, impotence, weight loss (cardiac cachexia)
- high pulmonary venous pressure from LHF (orthopnea, PND) - high venous pressure from RHF (edema, abdominal swelling) |
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what are the new york heart association classes of HF?
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I: no symptoms
II: symptoms on mod-severe exertion III: symptoms on mild exertion IV: symptoms at rest |
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what are some correctable causes of HF?
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- myocardial ischemia
- HTN - valvular disease - anemia - thyroid disease |
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what is the typical treatment for pts with HF & low LVEF?
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- ACEi
- aldo blockers - beta blockers - digoxin - diuretics |
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what is hydralazine?
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- increases cGMP
- arterioles > veins --> reduction in afterload - first-line therapy for CHF |
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what is nitroprusside?
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- short acting increase in cGMP --> releases NO
- can be used in acute HF |
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when in CHF do you use ionotropic agents? which ones would you use?
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- use them in acute HF if BP is low
- CONTRAINDICATED over time b/c accelerate development of HF - dobutamine in short term (beta agonist), also Milrinone (PDEi) |
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what is digitalis?
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- inhibits Na/K ATPase --> increases intracellular Na --> more Ca ends up available during contraction --> augments contractility
- does not reduce mortality |
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what is the most commonly used drug for suppression of ventricular arrythmias in pts with HF?
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- amiodarone
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what is the most effective way of preventing arrythmias in pts w/ HF?
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- prophylactic ICD
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