Heart Failure Flashcards
(22 cards)
Pressure overload
Caused by:
Sarcomeres added in ___ –> ____
Effect on wall thickness:
Effect on ventricle chamber:
Hypertension, valvular stenosis
Parallel –> concentric hypertrophy (thicker wall but no chamber size)
Increase thickness
Decreased LV chamber size
Volume overload
Caused by:
Sarcomeres added in ___ –> muscle fibers ___ increases
Effect on wall thickness:
Effect on ventricle chamber:
Valvular regurgitation, shunts
Series –> length
Thickness increase, decrease or unchange
Dilated chambers
Diastolic HF caused by
Pathologic findings:
pressure hypertrophy
Decrease LV chamber size
Decreased compliance
Decreased stroke volume
Disproportionate septal hypertrophy
Systolic HF caused by
Pathologic findings:
volume hypertrophy
4 chamber dilatation
Potential mitral/tricuspid valve regurgitation
Mural thrombus formation
Diastolic HF treatment options
Diuretics
Not many medications available
Treat underlying problem: hypertension, ischemia, DM
Drugs that affects neurohormonal activation
Beta blockers
ACE inhibitors
Angiotensin II blockers
Drugs that affect water and salt retention, vasoconstriction
Vasodilatators
Drugs that affect lung congestion, water and salt retention, vasoconstriction
Diuretics
Affects lung congestion
CPAP
Drugs that decreases CO
Inotropes
Drugs that decrease renal perfusion pressure
Vasopressors
Beta blockers approved for HF
Carvedilol
Metoprolol succinate
Bisoprolol
Cautions of beta blockers
Diabetes, recurrent hypoglycemia
HR <80-85 mmHg
Avoid beta blockers
Asthma w/ active bronchospasm
Initiation/dose increase when fluid overloaded
Abrupt discontinuation
Reflex tachycardia
Spironolactone =
Uses:
Aldosterone antagonist
Enhance diuresis w/ loop diuretics
Improve survival
On maximal HF therapy
*not much affect on BP
Hydralazine =
Uses:
Direct arterial vasodilators
Decrease systemic vascular resistance
Combine w/ nitrates to help mitigate nitrite intolerance
Nitrates =
Use:
Combined venodilator/arterial vasodilator
Pt w/ angina
Afterload reduction in those intolerant of ACE-1/ARB
Drugs most used in heart failure
Loop diuretics
Most effective symptomatic relief
Mechanism of action of loop diuretics
Inhibit chloride reabsorption in ascending limb of loop of Henle
Narrow therapeutic toxic ratio
Digitalis toxicity
Milrinone =
Mechanism:
Phosphodiesterase III Inhibitors
Positive inotrope (contraction) Arterial and venous vasodilator
Dobutamine =
Mechanism:
Beta adrenergic stimulating agent
Stimulates beta 1 > beta 2 > alpha receptors
Strong inotrope w/ weak vasodilatory effect due to beta 2 stimulation
