43-44 Mech of HF and Drugs Flashcards Preview

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Flashcards in 43-44 Mech of HF and Drugs Deck (66)
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1

What are the three cardinal manifestations of HF?

dyspnea, fatigue, fluid retention
[not all patients have fluid overload and thats why they don't call it congestive HF anymore]

2

T-F-- heart failure can occur when CO is high or low?

True

3

What are the 4 causes mentioned of HF when CO is high?

hyperthyroidism
beriberi
anemia
major AV shunts

4

Increased force of contraction is produced when?

increased sarcomere length during diastole- closely related to end diastolic filling pressure (pre-load)

5

What is the inotropic state of the heart-

contractile state of the heart determined by its contractile properties and influence of autonomic nerves and circulating catecholamine which can also influence HR

6

What protein pumps CA into the sarcoplasmic reticulum? out of the SR?

SERCA
RyR2

7

What proteins pump CA out of the cell?

Ca ATPase
NCX polarized

8

What pumps Ca into the myocyte during the depolarized state.

L-type Ca channel

9

What happens to the NCX Na/Ca exchanger during depolarization ?

breifly reverses so Ca goes into the cell

10

In heart failure what is systolic dysfunction? diastolic dysfunction?

1. abnormally weak contraction during systole
2. abnormal relaxation during diastole
[remember they can be individual or in combination]

11

T-F-- energy delivery, production and storage and energy utilization are thought to be heavily involved in pathogenesis of failure?

False-not involved

12

What are 5 signs and symptoms of HF?

1. numerous hemodynamic abnormalities
2. dysregulation of Ca homeostasis- impair contraction and relaxation
3. dysreg of contractile proteins and interferes with cross bridge recycling
4. densensitized b adrenergic pathway--> reduced Ca uptake in SR.
5.myocytes lost by cell death-->fibrosis

13

Reduction in CO does what?

activates SNA and RAS and increases venous volume

14

Increases in intravascular and ventricular volumes leads to what?

increased diastolic and systolic wall stress, leading to hypertrophic remodeling of the hear and impaired contraction

15

Neurohumoral mediated increases in arterial and venous constriction increase what?

ventricular after load and preload respectively

16

Neurohumoral activation (SNA, ANGII, and aldosterone) act directly on the myocardium to promote what?

Unfavorable remodeling via myocyte apoptosis and changes in gene expression and EM composition

17

Reduced function of both arterial and venous baroreceptors leads to what?

increased activity of SNA, RAS, and vasopressin

18

T-F--hypertrophied heart operates at a higher inotropic state?

False- lower

19

What happens in renal function due to sympathetic- induced vasoconstriction ?

Shunts blood from glomeruli, stimulates renin, -->NA retention, increased blood volume, edema

20

SNS RAS and vasopressin all react to sustain arterial pressure with low cardiac out put by what? good or bad?

1. increasing peripheral resistance
2. Not beneficial

21

What is the first thing we must do in the pharmacological treatment of HF?

correct any reversible causative factors
[arrythmias, hypertension, valve defects, anemia, thyrotoxicosis etc.]

22

AHA stage A and B include who? C and D?

at risk for heart failure
with heart failure

23

What is stage A? Drugs usually used?

1. at risk but w/out structural heart disease or symptoms
2. ACEI or ARBS

24

What is stage B? Drugs typically used?

1. Structural heart disease but without signs or symptoms
2.ACEI or ARB and Beta blockers

25

What is stage C? What drugs typically used/

1. structural heart disease with prior or current symptoms
2. diuretics, ACEI and beta blockers

26

What is stage D HF? Tx?

1. refractory HF requiring specialized interventions
2. drugs from classes A,B,C, end of life care, and extraordinary measures (transplant, inotropes, mechanical support, experimentals)

27

What drugs do we use for after load reduction?

ACEI, ARBs, isosorbide dinitrite or hydalazine

28

What diuresis drugs do we use for HF?

loop diuretics and thiazides, spironolactone

29

What drugs do we use for positive isotropy?

adrenergic agoinsts
cAMP phosphodiesterase inhibitors
digitalis glycosides

30

What are the only drugs to date that have reduced mortality when used alone?

ACEI
ARB
beta blockers