Cardiac Shock Flashcards
(28 cards)
define heart failure and the two types
HF- clinical syndrome resulting from impairment of ventricular filing or ejection
forward- too little blood leaves heart
backward- blood accumulates behind heart
symptoms of heart failure
edema, dyspnea, SOB, paroxysmal nocturnal dyspnea, fatigue, exercise intolerance
most common cuase of heart failure
myocardial disorders leading to ischemia
etiology of heart failure types
most common?
ischemic, hypertensive, valvular, rheumatic fever, congenital heart disease
systolic v diastolic heart failure
diastolic- impaired filling (backwards)
LVEF greater than 50
concentric hypertrophy
systolic- impaired ejection (forward)
LVEF less than 40
eccentric hypertrophy
how does systolic dysfunction effect the stalring curve?
refer to notes
draw a pressure-volume loop. how is it affected by changes to preload, afterload, and contractility?
refer to notes
characterization of heart disease severity
NYHA- 1 no limitations 2 slight limitations 3 marked limitations 4 cannot do physical activity
American College of Cardiology A- at high risk B- structural disease w/o symptoms C- strutural disease w/ history of symptoms D- HF despite therapy
describe the hemodynamic profiles and how they provide a guideline for treatment
refer to notes
neurohormonal responses to heart failure
short term- cardiac stimulation via B1-adrenergics, vasoconstriction, water retention, Na retention
long term- neurohormones, cytoskeleton signaling, cytokines, epigentics
helpful in short term but harmful long term
energy starvation causes and consequences
causes- increased myocyte demand, decreased energy supply, decreased energy release from ATP
consequences- impaired contractility, impaired membrane ion pump function, myocyte death
therapy w/ signs/symptoms of heart congestion
low Na diet
fluid restriction
diuretics (loop- Na/K/2Cl
therapies for diastolic HF
none
manage comorbidities
therapies for systolic HF
ACE-I, B-blockers, aldosterone antagonists, digoxin, inotropes, ARBs, etc
ACE inhibitors
Ag2 causes increased Na, aldosterone, and vasoconstriction
ACE inhibitors prevent conversion of Ag1 to active Ag2
ARBs
block effects of Ag2 at receptor
Ag2 causes increased Na, aldosterone, and vasoconstriction
indicated when pts dont tolerate ACE-I
aldosterone antagonists
spironolacrone- lots of off target effects- gynecomastia, breast pain, impotence
eplenerone- blocks mineral corticoid receptor
used in conjunction w/ ACE-I to prevent aldosterone escape
B- blockers
sympathetic activation correlates w/ heart disease severity
block sympathetic activation of heart
valsartan/sacubitril
used in place of ACE-I or ARB
valsartan is ARB
sacubitril is a neprilysin inhibitor- blocks degradation of ANP and BNP
comination of isosorbide/hydralazine
used for african americans
digoxin
cardiac glycoside
blocks Na/ K ATPase, increasing intracellular Na and contractility
no mortality benefits
irabradine
blocks If channel in nodes, slowing HR
no mortality benefits
inotropes
milrinone, dobutamine
increase contractility, but increase mortality
used as bridge or palliative care
two types of implantable devices
ICD- monitors for abnormal heart rhythm- can be used for primary or secondary prevention
CRT- indicated w/ HF and wide QRS on EKG. can also contain ICD
