EXAM #2: CONGESTIVE HEART FAILURE Flashcards Preview

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Flashcards in EXAM #2: CONGESTIVE HEART FAILURE Deck (44):
1

What is preload?

Tension developed on the wall of the ventricles before the start of contraction

****This is equal to the end diastolic volume, and EDV is equal to the atrial pressure****

2

What is the Frank Starling Principle?

More preload = more contractility TO A POINT

3

What is afterload?

The pressure the ventricle has to push against i.e. arterial pressure/ peripheral vascular resistance

4

What is the relationship between afterload and contractility?

Increasing afterload increases contractility to a point

*****This is called the anrep phenomenon*****

5

What is the relationship between the contractility and heart rate?

Faster heart rate will be associated with increased contraction

****This is called the Bowditch phenomenon*****

6

Draw the relationship between ventricular EDV and stroke volume. How is this changed in HF?

N/A

Generally, in HF you need MORE preload to produce the same amount of WORK.

7

Draw the pathophysiology of Heart Failure and the major drug action sites.

N/A

8

What is the main cause of HF?

Cardiac remodeling

9

What is stage A Heart Failure?

High risk for developing HF
- HTN
- CAD
- DM
- FHX of Cardiomyopathy

10

What is stage B Heart Failure?

Asymptomatic HF
- S/p MI
- LV systolic dysfunction
- Asymptomatic valvular disease

11

What is stage C Heart Failure?

Symptomatic HF
- Known structural heart disease
- Dyspnea/ Fatigue
- Reduced exercise tolerance

12

What is stage D Heart Failure?

Refractory End-Stage HF
- Symptoms at rest despite max. medical therapy

13

What drugs classes are used to treat Stage A HF?

1) ACEI or ARB

14

What drugs classes are used to treat Stage B HF?

1) ACEI or ARB
2) Beta-blocker

15

What drugs classes are used to treat Stage C HF?

1) ACEI or ARB
2) Beta-blocker
3) Diuretics

16

What drugs classes are used to treat Stage D HF?

1) ACEI or ARB
2) Beta-blocker
3) Diuretics
4) Digoxin
5) Positive ionotrope

17

What is the effect of diuretics alone on the pathophysiology of HF?

Shift to lower cardiac filling pressure on the same ventricular function curve

18

What is the effect of ionotropes alone on the pathophysiology of HF?

Shift to higher ventricular function curve BUT increased workload

19

What is the effect of vasodilators alone on the pathophysiology of HF?

Shift to improved ventricular function curve AND reduce cardiac filling pressure

20

What is the effect of vasodilators and ionotropes on the pathophysiology of HF?

Shift to improved ventricular function curve AND sight reduction in cardiac filling pressure

21

What is the effect of vasodilators, diuretics, and ionotropes on the pathophysiology of HF?

Shift to improved ventricular function curve AND significant reduction in cardiac filling pressure

22

What are the effects of beta agonists on myocardial contractility?

- Gs stimulation
- Increased cAMP
- Phosphorylation of the Ca++ channel in the sarcolemma
- Increased Ca++ induced Ca++ release

Positive ionotropy

23

How can intrinsic myocardial activity be increased?

1) Increase cytosolic Ca++
2) Increased myocardial cAMP
3) Agonism of B1 receptors
4) Increase B1 density

24

What drugs increase cytosolic Ca++?

Cardiac Glycosides i.e. Digoxin

25

What drugs increase myocardial cAMP?

Phosphodiesterase inhibitors

26

What drugs agonise B1 receptors?

Isupreal
Dobutamine
DA
Epi
NE

27

What drugs increase B1 receptor denisty?

Beta-1 ANTAGONISTS

28

What is the mechanism of action of digoxin?

1) Block Na+/K+ ATPase
2) Accumulation of intracellular Na+
3) Reduction in Na+/Ca++ exchange
4) INFLUX of Ca++ from extracellular space

*****Net ionotropic effect*****

29

What are the cardiac effects of Digoxin?

1) Positive ionotropy
2) Direct vagal effect
3) Increased coronary blood flow
4) Proarrhythmic

30

Why is digoxin used in patients with A-fib w/ RVR?

Direct vagal effect decreases AV conduction

31

What EKG change is characteristic of Digoxin?

Hockey stick ST depression

32

What is the proarrhythmic effect of digoxin related to?

K+

33

What is the half-life of digoxin?

36-48 hours

34

How long does it take to achieve steady-state blood levels of digoxin?

7 days

35

How is digoxin excreted?

Kidney

36

What are the adverse effects of Digoxin?

1) Hypokalemia
2) Acid-base disbalance
3) Arrhythmia (AV block)

37

What are the first symptoms that patients complain of with digoxin that should be concerning to you?

Anorexia
Nausea
Vomiting
Visual distrubance

38

What is the role of Digoxin in the treatment of HF?

Used frequently in HF, especially in CHF and a-fib w/ RVR; however
- Improves quality of life but NOT all-cause mortality

39

How is Digoxin overdose reversed?

Cholestyramine

40

List the phosphodiesterase 3 inhibitors.

Inamrione
Milrinone

41

What is the mechanism of action of the phosphodiesterase 3 inhibitors?

- Type III Phosphodiesterase degrades cAMP
- inhibition INCREASES cAMP

42

What is the effect of cAMP in the heart?

Increased intracellular Ca++ leading to enhanced contractility

43

What are the cardiovascular effects of the phosphodiesterase 3 inhibitors?

- Positive ionotrope
- Positive lusotropy
- Balanced venous and arterial dilation

****All increase CO****

44

What setting are Inamrinone and Milrinone used in?

ICU i.e. only for short-term support of advanced CHF

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