100614 heart failure Flashcards

1
Q

three major determinants of stroke volume

A

contractility, preload, afterload

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2
Q

afterload is related to

A

wall stress, which is directly related to aortic pressure and the radius of the ventricle and inversely related to wall thickness of the ventricle

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3
Q

point a on pressure volume loop is

A

mitral valve opening and beginning of diastole

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4
Q

point b-c on pressure volume loops is

A

isovolumic contraction after mitral valve closure

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5
Q

d-a on pressure volume loops

A

isovolumic relaxation after aortic valve closure

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6
Q

which pt on P-V loop represents end systolic volume?

A

d

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7
Q

which curve on PV loop is compliance?

A

ab

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8
Q

which curve on PV loops is afterload?

A

cd

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9
Q

what is stroke volume on PV loops?

A

b - d

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10
Q

heart failure is due to abnormal

A

emptying

filling

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11
Q

what are some precipitating factors for heart failure?

A

increased metabolic demands

increased circulating volume (increases preload)–like salt, renal failure

conditions that increase afterload

conditions that impair contractility

failure to takeheart failure meds

excessively slow HR

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12
Q

physical findings for left sided heart failure

A

diaphoresis
tachycardia, tachypnea
pulmonary rales

loud P2
S3 gallop (in systolic dysfxn)
S4 gallop (in diastolic dysfxn)
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13
Q

NY heart association classification of heart failure

A

class I: mild. cardiac disease, but no limits in physical activity

class II: mild. slight limitation of physical activity. dyspnea and fatigue with moderate exertion.

class III: moderate. marked limitation of physical activity. dyspnea with minimal exertion. comfortable only at rest.

class IV: severe. severe limitation of activity. symptoms present at rest.

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14
Q

what is the long term effect of positive inotropes in treating chronic heart failure with reduced ejection fraction?

A

no beneficial long term effect

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15
Q

digoxin primary effects

A

positive inotrope-increases the contractile state of myocardium, increasing stroke volume

increases vagal tone (slows HR)

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16
Q

secondary effects of digoxin

A

decreases HR
arterial and venous dilation
decreased venous pressure
normalized arterial baroreceptors

17
Q

how does digoxin work as a positive inotrope?

A

inhibits Na K ATPase

indirectly results in increased intracellular calcium level

18
Q

neurohormonal activation

A

activation of sympathetic system
activation of renin angiotensin aldoesterone axis
release of ADH

19
Q

side effects of digoxin

A

really bad

low therapeutic index
affects all excitable tissues (GI, visual, neurologic, muscular, cardiac-arrhythmias)

toxicity enhanced with hypokalemia

drug interactions (quinidine, verapamil, amiodarone)

20
Q

use of digoxin

A

not first line tx

use limited to heart failure pts with LV systolic dysfxn in atrial fibrillation or in some cases to pts in sinus rhythm who remain symptomatic despite maximal therapy with other therapies

21
Q

furosemide side effect

A

hypokalemia

22
Q

use of furosemide

A

widely used chronically for heart failure patients with reduced ejection fraction

23
Q

use of chlorothiazide

A

rarely used alone

combo therapy with loop diuretics

24
Q

side effect of chlorothiazide

A

hypokalemia

25
Q

amiloride and triamterene effects as diuretic

A

weak, but limited K and Mg wasting

26
Q

hydralazine

A

arterial vasodilator

27
Q

mixed vasodilators ex

A

ACE inhibitors
ARBs
isorbide dinitrate/hydralazine combo

28
Q

angiotensin has effects on

A

potent arterial constrictor (afterload)

Na and water retention through aldosterone secretion

promotes sympathetic activation by increasing neuronal and adrenal medullary catecholamine release

arrhytomogenic

promotes myocardial hypertrophy and apoptosis

29
Q

aldosterone effects

A

promotes water and Na retention and potassium secretion

stimulates fibrosis in heart and vasculature

cardiac hypertrophy

30
Q

side effects of ACE inhibitors

A

hyperkalemia

angioedema
hypotension
dry cough

31
Q

use of ARBs

A

alternative for pts that cannot tolerate ACE inhibitors

32
Q

use of isosorbide dinitrate/hydralazine combo

A

used when ACE inhibitors or ARBS not tolerated

33
Q

aldosterone antagonist ex

A

spironolactone, eplerenone

34
Q

side effect of aldosterone antagonist

A

hyperkalemia

35
Q

uses of aldosterone antagonist

A

added with moderately severe to severe heart failure

36
Q

non drug therapies for chronic heart failure involving reduced ejection fraction

A
salt restriction
bi ventricular pacing
implantable cardidefibrillator devices (ICD)
left ventricular assist device
heart transplant
37
Q

tx of heart failure with preserved ejection fraction

A

diuretics to reduce pulmonary congestion and peripheral edema (but use cautiously to avoid under filling of LV)

note: all of the flashcards for drugs before this one (this is the last card) have been for chronic heart failure with reduced ejection fractions