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Flashcards in Inotropic Agents I and II Deck (58)
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1

How is CHF defined?

inability of the heart to pump blood at a rate commensurate with the requirements of the tissues

2

How is heart failure defined?

any structural or functional disorder that impairs the ability of the ventricle to fill with or eject blood

3

What are the clinical manifestations of heart failure?

dyspnea
fatigue
fluid retention (CONGESTIVE)

4

Does the ventricle size and function have to be abnormal?

no

5

According to the New York Heart Associations Functional Classifications, how is the following patient classified:
Patient is diagnosed with cardiac disease but it has no impairment in their life.

Class I

6

According to the New York Heart Associations Functional Classifications, how is the following patient classified:
A patient with cardiac disease who has been running 5 miles a day for 20 years can now only run 3-4 miles at the most before becoming exhausted and short of breath, but they have no symptoms at rest.

Class II

7

According to the New York Heart Associations Functional Classifications, how is the following patient classified:
A patient with cardiac disease who has been running 5 miles a day for 20 years and is now fatigued and out of breath walking to his mailbox and back, but they have no symptoms at rest.

Class III

8

According to the New York Heart Associations Functional Classifications, how is the following patient classified:
A patient with cardiac disease who is constantly fatigued and short of breath by walking around their house and has similar symptoms even while he is resting.

Class IV

9

There is a poor correlation between cardiac function and....

symptoms

10

Name some noncardiac factors that affect exercise tolerance.

-peripheral vascular fxn
-skeletal muscle physiology
-pulmonary dynamics
-neurohormonal and reflex autonomics
-renal Na handling

11

How does LV dysfunction usually begin?

with injury to myocardium (usually progresses by change in geometry and structure)

12

Which hormones and neurotransmitters are elevated in patients with heart failure?

Norepi
Angiotensin II
Aldosterone
Endothelin
Vasopressin
Cytokines

13

What are the compensatory mechanisms of the heart in heart failure?

increased HR, contractile stimulation and rate of relaxation

14

What are the compensatory mechanisms of the peripheral circulation in heart failure?

arterial vasoconstriction (increased afterload)
venous vasoconstriction (increased preload)

15

What are the compensatory mechanisms of the kidney in heart failure?

arterial vasoconstriction
venous vasoconstriction
Na and water retention
increased myocardial contractile stimulation

16

What are the compensatory mechanisms of oxygen delivery in heart failure?

-redistribution of cardiac output
-altered O2 Hgb dissociation
-increased O2 extraction by tissues

17

Which two stages are at risk for heart failure and how are they differentiated?

-Stage A and B
-B has structural heart disease, A does not

18

Which two stages are in heart failure and how are they differentiated?

-Stage C and D
-D has refractory symptoms of HF at rest

19

How are patients in Stage A treated?

-reduce risk factors
-ACEI or ARD

20

How are patients in Stage B treated?

Stage A + ACEI, ARB or Beta blockers

21

How are patients in Stage C treated?

Stage B+
-Diuretics
-ACEI
-Beta Blockers
-Aldo Antagonist
-ARB
-digitalis
-nitrates
-pacemaker
-defibrillators

22

How are patients in Stage D treated?

Stage C+
-end of life care
-transplant
-chronic inotropes
-mechanical support
-experimental surgery or drugs

23

What is the first line therapy for heart failure?

ACEI's
-alleviate symptoms, improve clinical status and reduce risk of death and hospitalization

24

What are the physiological effects of ACEI's?

-arteriovenous vasodilation (decrease SVR, BP, PCWP, and LVEDP, increases CO and exercise tolerance)
-no change in HR or contractility
-decreased O2 requirements
-Increased renal, coronary and cerebral blood flow
-diuresis and naturesis

25

What are the advantages of ACEI's?

-Inhibit LV remodeling after MI
-modify the progression of chronic CHF
-No neurohormonal activation or reflex tachy
-no tolerance

26

what is one benefit of the ARB's over the ACEI's?

no side effect of cough

27

How do ARB's work?

block type 1 angiotensin II:
-dilate arteries and veins
-inhib angiotensin II effect on sympathetic tone
-promotes renal excretion of Na and water
-inhibits cardiac and vascular remodeling

28

When would using an ACEI and an ARB be indicated?

in patients with resistant hypertension

29

When there is a side effect of ____________ with and ACEI, adding an ARB is contraindicated.

angioedema-crossover effect

30

Name the 6 ARB drugs.

-Losartan
-Irbesartan
-Valsartan
-Candesartan
-Olmesartan
-Telmisartan