Heart Failure Flashcards
(25 cards)
Define heart failure in animals
Inability of heart to maintain adequate cardiac output for metabolic needs
What triggers neurohormonal activation in HF?
Reduced cardiac output activates RAAS and sympathetic nervous system lead to vasoconstriction, sodium and water retention and cardiac remodeling
Differentiate left vs right sided CHF signs
Left -pulmonary edema(cough,dyspnea, crackles)
Right-ascites, jugular dissension , hepatic congestion
Name 3 low output signs of HF
Weakness
Syncope
Cyanosis
Rerenal azotemia
Role of furosemide in HF?
Loop diuretics block Na+/K+/Cl- reabsorption in Henle’s loop to reduce pulmonary edema
Acute HF : high IV doses
Chronic HF : lowest effective dose (avoid azotemia)
Why add ACE inhibitors?
Block RAAS to reduce preload and after load thus reduce remodeling
Cation monitor:hyperkalemia and renal function
When is Spironolactone used?
Refractory CHF (K+ sparing diuretic) lead to mild diuresis + anti-remodeling effects
Risk- hyperkalemia ( avoid with ACEi /K+ supplements)
Which vasodilator is best for acute pulmonary edema ?
Nitroglycerin ointment (venodilator)
Hydralazine ( arteriolar dilator)
How does amlodipine differ in cats and dogs ?
Cats-1st like for hypertension (0.625-1.25mg/kg/day)
Dogs: adjunct for mitral valve disease
Why avoid NSAIDs in HF patients ?
Worsen renal perfusion by increasing risk of azotemia especially with diuretics and ACEi
How to treat fulminant pulmonary edema?
- Oxygen + IV furosemide
2.nitroprusside IV
What’s the biggest risk of over diuresis
Prerenal azotemia
Check BUN / creatinine
How to monitor chronic HF treatment?
Renal function (BUN/Cr)
Electrolytes ( K+ for ACEi/spironolactone)
Respiratory effort ( crackles =edema recurrence )
What causes diuretic resistance
Long term furosemide >nephron adaptation> increase Na+ reabsorption
Fix=adding thiazides
List key information to jot down in medical history
Activity level of dog
Has there been any coughing ?
Does the tongue/Mucous membrane look pink during exercise?
Are medications being given?
Age, gender and breed
What to look for during physical exam in HF?
Evaluate peripheral circulation ie mucous membranes
Systemic veins ie JVD
Precordium(ascites , pleural effusion)
Systemic arterial pulses (femoral arteries)
Causes of HF
Drugs-steroids
Hypertension
COronary heart disease
Nutritional deficiencies
Goals of treatment in HF
Improve cardiac output
Manage concurrent arrhythmia
Supper myocardial function
Reduce cardiac workload
Control edema and effusions
List adverse effects of furosemide
Metabolic alkalosis
Increase toxicity with digoxin
Diuretic resistance
Azotemia
Spironalactone mechanism and S/E
Inhibit action of aldosterone on distal tubular cells or by blocking sodium reabsorption in the latter regions in the distal tubule and collecting tubules
S/E-facial excoriation has been reported in cats
Excess K+ retention
GI distrubance
Spironolactone mechanism and side effects
Inhibit action of aldosterone on distal tubular cells or by blocking sodium reabsorption in the latter regions in the distal tubule and collecting tubules
S/E-facial excoriation has been reported in cats
Excess K+ retention
GI disturbance
Adverse effects of ACEi
Hypotension
gi upset
Hyperkalemia
Azotemia
Mechanism of amlodipine
Block Ca+2 influx across cardiac and vascular smooth muscle cell membranes
