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39 Cards in this Set
- Front
- Back
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What causes systolic dysfunction? What are the effects on the stroke volume?
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Decreased contractility.
Increased ESV, compensatory increase in EDV. Net decrease in SV |
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What is diastolic dysfunction? What are the effects on SV?
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Decreased relaxation.
Decreased EDV and SV |
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What systems are activated in response to decreased cardiac output? What hormones are released?
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Sympathetic and RAAS systems activated.
Release of vasopressin, natriuretic peptides, prostaglandins, and nitric oxide. |
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What are the net effects of decreased cardiac output activation of the sympathetic and RAAs systems?
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Vasoconstriction
Venous constriction Cardiac stimulation Increased volume Cardiac remodeling |
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What phase is shortened in increasing heart rate? What is the result?
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Diastole is shortened.
Calcium can overload, due to decreased removal, predisposing to arrhythmias. Increased myocardial demand, worsening ischemia. |
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What are the effects of decreased EF in left ventricular failure? What are the effects in right ventricular failure?
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Left- pulmonary edema, dyspnea
Right- systemic edema, reduced renal perfusion (increased RAAS) |
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What are the consequences of increased afterload in a failing heart?
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Reduced velocity of contraction, causing increased EDV and decreased SV.
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How does the ventricle hypertrophy at the cellular level? Organ level?
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Cells change gene expression, fibroblasts and cardiomyocyte hypertrophy.
The heart changes shape and size |
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What are the consequences of cardiac hypertrophy?
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Impaired ventricular filling.
Increased myocyte death. Abnormal forces on papillary muscle. |
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What are the main treatment goals for heart failure?
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Reduce mortality
Reduce morbidity (symptoms, edema, reduce hospitalizations) Prevent complications (prevent myocardial damage, remodeling and recurrence of symptoms) |
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Why are diuretics used in heart failure?
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Symptoms result from excessive salt and water retention.
Reducing the volume also improves pumping efficiency. |
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What kind of diuretics are used in heart failure?
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Loop diuretics- furosemide, bumetanide
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Why are ACE inhibitors used in heart failure?
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Used in all patients who have heart failure or risk of heart failure.
Prevents effects of angiotensin II- decreases preload and afterload, reverses LV remodeling, reduces risk of MI, prolongs life and prevents hospitalization. |
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When are ACE inhibitors contraindicated in heart failure patients?
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Fluid retention can occur.
Angioedema, renal stenosis, pregnancy |
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Why are beta- receptor antagonists used in heart failure?
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Added to ACE inhibitor when patients are symptomatic. Decreased cardiac work, decreases HR, decreases myocyte death.
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When are beta blockers contraindicated in heart failure? When is it not contraindicated?
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Bradycardia
AV block NOT in COPD, peripheral artery disease, diabetes |
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Why is spironolactone (aldosterone antagonist) used in heart failure?
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Used for patients who have LVEF less than 35% or advanced symptoms.
Prevent risks of electrolyte imbalance, water retention, LV remodeling, sympathetic activity. Decreases risk of mortality. |
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When is spironolactone cautioned in heart failure?
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Hyperkalemia
Gynecomastia/ menstrual irregularities |
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Which nitrovasodilators are used to treat heart failure? How do they work?
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Nitroglycerin
Isosorbide Relax vascular smooth muscle by increasing NO; dilate veins at low dose, veins and arteries at high dose. |
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For which patients is hydralazine+isosorbide recommended?
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African americans with class III-IV HF
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What is digitalis used to treat?
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Heart failure
Arrhythmia |
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What is the response to digitalis therapy in heart failure?
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Decreased sympathetic
Increased diuresis Decreased edema Decreased blood volume Decreased preload Decreased pulmonary |
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How does digitalis work?
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Inhibits the sodium-potassium ATPase, causing less sodium to be pumped from the cytoplasm.
Excess sodium affects the sodium/calcium transporter. Less sodium enters during systole and more leaves during systole. Overall increase in calcium causes enhanced contractility. |
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What are the direct cardiac effects of digitalis?
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Increases contractility, which also decreases preload.
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What causes digitalis toxicity?
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Hypokalemia
Drug interactions |
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What are symptoms of digitalis toxicity?
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Weakness
Palpitations- AV block Syncope Dyspnea CNS- confusion, dizziness, headache Ocular- yellow/green vision, scotomas GI |
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How is digitalis toxicity treated?
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Limit absorption and increase elimination
Correct electrolyte abnormality Administer antiarrhythmic |
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What is the treatment for stage A heart failure?
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Treat comorbidities.
Lifestyle modification. ACE-I and ARBs |
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What is the treatment for stage B heart failure?
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Treat comorbidities.
Lifestyle modification. ACE-I or ARB Beta blockers |
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What is the treatment for stage C heart failure?
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Dietary salt restriction.
Diuretics ACE-I Beta blockers In some, add aldosterone antagonist, hydralazine/isosorbide, or digoxin |
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What is the treatment for stage D heart failure?
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Diuretics
ACE-I Beta blockers Heart transplant Mechanical support Positive inotropic agents (digoxin) Hospice |
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What are the treatment goals for acute heart failure?
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Reduce excess extracellular volume
Improve hemodynamic function Maintain perfusion to vital organs |
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What drugs are used to treat acute heart failure?
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Loop diuretics
Vasodilators- nitroglycerin, sodium nitroprusside, nesiritide |
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What is the mechanism of nesiritide?
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Synthetic BNP.
Dilates arterial and venous vessels to improve hemodynamic function and lower resistance. |
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What is the mechanism of milrinone?
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Increases cAMP concentrations to relax vascular smooth muscle.
Increases cardiac output (inotrope) |
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What is the mechanism for dobutamine?
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Beta1 selective receptor agonist.
Used in acute hypotensive heart failure or shock. |
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What is the effect of low dose dopamine? Moderate dose? High dose?
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Low dose- stimulates D1 receptors in kidney to vasodilate.
Moderate dose- stimulate beta receptors in heart High dose- stimulate alpha receptors to cause vasoconstriction. |
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What are the uses of inotropes?
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Low systemic blood pressure or low CO with decreased perfusion.
Stabilize patient in shock. May worsen myocardial damage and increase mortality. |
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What are the goals of treating diastolic heart failure? What is avoided in treatment?
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Control hypertension
Control pulmonary edema Control tachycardia/ a fib Avoid inotropes because the heart has no problem contracting, only relaxing. |
