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16 Cards in this Set

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  • Back
Describe the body's extrinsic compensatory mechanism in Heart Failure. This leads to what reflex being reset?
With decreased Cardiac output and decreased contractility, the body stimulates the SNS and the Renin-Angiotensin-Aldosterone system. Baroreceptor reflex is reset due to increased SNS output.
Describe the initial effect of the SNS stimulation in HF.
Initially, SNS stimulation leads to Tachycardia with increased cardiac contractility, increased vascular tone resulting in increased cardiac output.
Describe the effect of the R-A-A system on HF.
Angiotensin II production further increases afterload via Na+ and water retention. This leads to worsening HF.
Describe the intrinisc compensatory mechanisms involved in HF.
Myocardial hypertrophy cuased by increased heart activity and elevated AII level.
TRUE/FALSE - Oral administration of cardiac glycosides (e.g. digitalis,digoxin) has a narrow therapeutic index.
Describe the mechanism of caridac glycosides.
Potent Inhibitor of Na/K ATPase which leads to increased Calcium intracellular concentration (increased intracellular Na impairs Na/Ca exchanger). This leads to increased cardiac contractility.
Bipyridines (e.g. Inamrinone, milrinone) are relatively toxic and work by what 2 mechanisms? What is their physiologic effect?
1. Bipyridines inhibit PDE 3 isozyme (cAMP) in cardiac and smooth muscle, leading to increased inward flux of Ca during AP (increase contractility(PKA);
2.vasodilation via PKA activation, which promotes muscle relaxation via diminished myosin phosph. & increased Ca sequesteration
What is the later effect of prolonged SNS stimulation in HF?
Since the Heart is unable to handle the increasing
Afterload. Prolonged HF leads to decreased ejection fraction, cardiac output decrease, & renal perfusion decrease.
Beta 1 selective agonists (e.g. dobutamine) work by what mechanism in HF?
Increased Cardiac contractility/cardiac output via protein kinase A and increased [Ca2+]in.
Describe the mechanims of Diuretics (e.g. sprinolactone) in HF.
Diuretics increase urine volume, reduce venous pressure and therefore Preload.
What are the physiologic benefits of diuretics in HF?
Reduce edema, cardiac size, improves cardiac efficiency
Describe the mechanism and physiologic effects of ACE inhibitors.
Mechanism is the blockage of AII production. This leads to decreases in AL, PL, and PVR.
TRUE/FALSE - Vasodilators (e.g. nitrates, nitrites, CCBs) can dilate veins & arterioles and increase contractility.
False - No positive inotropic effects
Beta blockers (e.g. bisoprolol, carvedilol, metoprolol) inprove mortalitiy in HF. What effect do these drugs have on HR and CTY?
Negative inotropic and chronotropic effets.
TRUE/FALSE - Only 1/2 of patients with HF survive after 5 years even with standard of care therapy.
Is digitalis + a diuretic, the current standard of care for treating HF?
In the past, both were standard of care. Now, digitalis is reserved for those who do not respond to diuretics + ACE In + Beta blockers.