19. heart failure 1

Question 1

define cardiac failure

Answer 1

pump failure due to structural & functional disorder iimpairing the ability of ventricles to fill or eject blood decreasing CO

Question 2

decompensation

Answer 2

in spite of compensatory mechanisms the CO not able to supply the tissue in O2

Question 3

factors determining cardiac performance

Answer 3

• HR
• prefload and afterload
• contractility

Question 4

what are the underlying causes

Answer 4

• MI
• IHD
• valvular pathologies
• CMP
• congential heard defects

Question 5

types of heat failures

Answer 5

systolic = decreased contractility and EF <40%

diastolic = decreased relaxation and ej can be mild or normal

Question 6

stages of NYHA

Answer 6

4 classes look them up on google

Question 7

treatment

Answer 7

1. prevention + non pharmacological
2. drug treatment
3. invasive therapy

Question 8

drugs used in HF

Answer 8

positive ionotropic drugs
vasodilators
miscellaneous drugs for CHF

Question 9

postiive ionotropic drugs

Answer 9

• cardiac glycosides (digoxin)
• b-agonists (dobutamine)
• PDE inhibitors (inamrinone)

Question 10

vasodilators

Answer 10

PDE inhibitors (inamrinone)
nitroprusside, nitrates, hydralazinw
-loop diuretics, ACEi, nesiritide

Question 11

Aims

Answer 11

decrease the preload, afterload, remodelling,

increase the contractility

Question 12

what’s used in decreasing pre & after load

Answer 12

diuretics, vasodilators, RAAS i

Question 13

what’s used in order to increase contraction

Answer 13

+ ionotropic agents

Question 14

aim in treating chronic HF

Answer 14

• relieve sypmtoms
• improve hemodynamic state
• decrease hospitalization
• decrease mortality

Question 15

NYHA 1-2

Answer 15

diuretics, ace, ARBs, b blockers, aldosterone antagonists

Question 16

NYHA 3-4

Answer 16

duiretics, cardiac glycosides, sympathomimitics, vasodilators

Question 17

RAAS inhibitors: MOA, drugs

Answer 17

HF activates RAAS because it decreases perfusion of kidney, renin release, promoted by SY stimulation

drugs: Captopril (ACEi)
losartan (ARB)

Question 18

ACEi captopril

Answer 18

• decrese vasocontriction, after & preload leading to increased CO
• increase brandykinin leading to dialtion,
• decreasing aldosterone
  indication: HF with reduced ejection fraction and is combined with other drugs

Question 19

ARB’s losartan

Answer 19

competitive inhibition of angiotensin 2 on AT1 receptors

- decrease afterload and preload leading to a increase cardiac output

Question 20

diuretics 1st line for? some examples

Answer 20

1st line for both systolic and diastolic HF, decreases preload and oafterload

• aldosterone antagonists
• potassium excreting

Question 21

Aldosterone antagonists

Answer 21

• eplerenone, sprionolactone
• prevents salt retention, mycardial hypertrophy, hypokalemia and decreases remodeling
  indication: sever hf with reduced ejectionf raction + MI

Question 22

potassiu, excreteing

Answer 22

• relieve pulmonary HT + peripheral edema
• decrease sypmtoms of volume overload
• decrease the preload leading ot decrease cardiac work and O2 demand
• decrease the afterload leading to decreased pressure
  indication: increase survival of HF patients with renal insufficiency

Question 23

vaso and veno dilators

use, examples, indication, adverse effects

Answer 23

• decrease pre and afterload
• nitrates, hydralazine, nitroprusside
• HF w/ EF + intolerance to ACEi + BB

Question 24

Heart rate controllers

Answer 24

ivabradine: block I.f channel ->decreasing HR

- Ranolazine - block late Na ch-> decreasing ca -> decreased contractility

Question 25

BB use, examples, indication, adverse effects

Answer 25

-increase systolic function, reverse cardiac remodelling -decrease HR, decrease hyper trophy -inhibit renin reliease bisprolol, nebivolol, metoprolol, carvedilol - indication: HF, HF r EF

Question 26

+ ionotropicdrugs

Answer 26

``` 1- heart glycosides 2-B agonists 3-PDE inhibitors 4-calcium sensitizers 5-new grugs for acute HF ```

Question 27

examples of B agonists

Answer 27

dobutamine | dopamine

Question 28

dobutamine use, examples, indication, adverse effects

Answer 28

b1 stimulation -> gs-> increase in cAMP leading to + ino,dromo, chronotropy racemic + isomer = b1 agnosits + alpha1 antagonist -short half life, drop infusion -indication:acute HF : cardiogenic shock, MI,heart surgery, OD on BB, acute decompensation in congestive HF - adverse effects: tachycardia, arrythmia, tachypylaxis

Question 29

dopamine use, examples, indication, adverse effects

Answer 29

- low dose D1 leading to decrease in NE -> vasodilation in viscera - meduim dose b1 stimulation -> +ionotropy - high dose: alpha1 -> vasoconstriction - indication: cardiogenic shock, increase perfusion in kidneys + splanchnic area - adverse effects: tachycardia, tolerance, bad pharmacokinetics

Question 30

PDE inhibitors use, examples, indication, adverse effects

Answer 30

-increase cAMP, vasodilation leading to a decrease in TPR, used in acute HF adverse effects: thrombocytopenia , hepatotoxic, HF contraindicated in aortic stenosis, HCM examples: bipyridines: amirone, milrinone methylxanthine derivatives: theophyllin, aminophyllin other: vesnarinon

Question 31

calcium sensitizers

Answer 31

enhancement of ca sensitivity of tropinin c myofibrils, they dont increase cAMP or ca indication: acture decompensation of severe chronic HF benzimadazoles: primobendan: oral,iv, inhibit PDE, narrow T.I levosimendan: infusion IV, open ATP dep K ch. leading to vasodilation

Question 32

new drugs for acute HF:

Answer 32

-endothelin 1 ATG: bosetan ambrisentan oral, toxic, (i) pulm HT, raynaud -endothelin convertase inhibitor: phosphoramidon -BNP: nesiritide, IV bolus t1/2 about 20 min. (I) absolute refractory HF leads to an increase in cGMP leading to VD its nephrotoix -othersL coEZ Q10, aliskiren, serelaxin