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39 Cards in this Set
- Front
- Back
What is the problem in LOHF?
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Inability of heart to maintain CO--Early compensated(elevated venous filling pressure to increase VR yields asymptomatic) and Late Decompensated(heart can't meet metabolic demands and so symptomatic)
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What are the chronic LOHF causes?
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Hypertension, acute myocardial infarction, and idiopathic dilated CM
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What do lusitropic drugs do?
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Affect diastolic function and relaxation
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What is the status of diastolic HF?
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Ventricles hypertrophy because there is increased afterload--this causes the heart to get too thick and be unable to relax properly to allow in atrial blood--so it backs up
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Which has a change in EF, diastolic or systolic HF?
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Systolic--diastolic EF stays the same even though SV goes down because the thick heart muscle is able to eject the same fraction
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An S4 sound indicates what? Why?
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Diastolic HF--Heart is very rigid and not relaxing and when it tries to push the blood out, you get a 4th heart sound
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An S3 sound indicates what? Why?
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Systolic Hf--EDV is increased and so there is an increase in residual blood in the heart, leading to the 3rd heart sound
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Diastolic HF
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Thick walled ventricle that squeezes fine
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Systolic HF
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Thin walled ventricle that can't squeeze well and makes an S3
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What are the 4 compensatory mechanisms for LOCHF?
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Starling adjustment, baroreceptor reflex, renal mechanism, and myocardial hypertophy
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What is the cardiac reserve?
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Upgrade from normal operating point to max function
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What are some negative inotropic agents?
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ACh, vagal stimulation, anoxia, fatigue
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What are some positive inotropic agents?
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Epi and Norepi
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What does calcium bind in the myocyte?
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TROPONIN C
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What is the difference between isometric contraction and isotonic contraction?
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Isometric--flexing muscle doesn't do any work(increases tone but not mass)
Isotonic--muscle does work and increases in mass(increasing afterload causes the heart to do this type of work) |
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What is the abdominojugular test?
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Push on the liver and see if the IJV pops out
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What are the pharm approaches to low output HF?
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Decrease preload = decrease veinous return with diuretics and venodilators--decrease Afterload = vasodilators and RA antagonists
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What is the order of treatment for HF?
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Diuretics and Aldosterone inhibitors--ACE inhibitors and Beta blockers(SELECTIVE so not propanolol) and vasodilators--Inotropic agents to increase contractility
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What are three diuretics?
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Thiazides, loop diuretics, and Triamterene
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What are three bad actions of Aldosterone?
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Retain Na+ and water--Excrete K+ and Mg++--Cause collagen deposition leading to fibrosis
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Spironolactone
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ALDOSTERONE INHIBITOR(competitive antagonist)
increases Na+ and Water absorption AE: Anti adrenergic and mimics steroids to cause hormonal changes |
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Eplerenone
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ALDOSTERONE ANTAGONIST
Similar to spironolactone but more specific to mineralcorticoid receptors Shorter half life than spironolactone |
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What effect do ACE inhibitors have on the vessels?
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They cause arteriovenous vasodilation--increase CO and increase exercise tolerance
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True/False: ACE inhibitors increase vasodilation and also HR
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FALSE--they don't increase HR
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Look at notes because all you did was drug slides
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Do it
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Catopril
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1st gen ACE inhibitor
Not tolerated by patients with sulfa drug allergy |
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Enalapril
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2nd Gen ACE Inhibitor
Prodrug so action is delayed |
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Lisinopril
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3rd Gen ACE Inhibitor
Direct acting |
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Fosinopril
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ACE inhibitor that isn't metabolized in the liver so it can be used in liver failure patients but it is excreted in the kidneys so be careful
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What is the most common ACE inhibitor side effect? Why?
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Dry cough because you are inhibiting Kininase II
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Losartan and Valsartan
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1st gen AT1 inhibitors
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Ibersartan and Candesartan
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2nd Gen AT1 inhibitors
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What three drugs can be used for HF that are beta blockers?
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Metoprolol, Carvedilol, and Bisoprolol
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What are the venodilators?
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Nitrates: isosorbide dinitrate and nitroglycerin
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What are afterload decreasing drugs?
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HYDRALAZINE
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Dobutamine
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Beta 1 stimulator
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Isoproterenol
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Beta 1/2 stimulator
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Dopamine
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B1 stimulator and D1 stimulator(vasorelaxation
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Amrinone, Milnorone, Vesnarinone
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PDE Inhibitors--improve cAMP so in the heart causes contraction and in the VSM it causes relaxation
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