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a. cardiovascular pathophysiology > Management of Heart Disease and Heart Failure > Flashcards

Management of Heart Disease and Heart Failure Flashcards

1
Q

what main things can confirm congestive heart failure?

A

clinical signs compatible with
radiographic evidence of CHF
elevated NT-proBNP
jugular distention with ascites

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2
Q

what specific outcomes of interest do we use in veterinary medicine when choosing drugs?

A

prolonged survival
improved quality of life

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3
Q

what is valsartan?

A

angiotensin receptor blocker

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4
Q

what is a neprilyin inhibitor?

A

sacubitril

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5
Q

what is neprilysin?

A

membrane bound endopeptidase

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6
Q

what does a neprilysin inhibitor do when given alone?

A

increases vasodilation and vasoconstriction

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7
Q

what is sodium glucose co-transporter-2?

A

a main enzyme for reabsorption of filtered glucose from the renal tubules

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8
Q

what are the four most important drugs for CHF?

A

furosemide or torsemide
pimobendan
ACE inhibitors
spironolactone

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9
Q

what is furosemide indicated for?

A

cardiogenic edema: pulmonary edema, pleural effusion, ascites

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10
Q

where does furosemide work?

A

ascending limb loop of henle

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11
Q

what does furosemide do?

A

blocks resorption chloride and electrolytes: impairs Na/K/2Cl cotransporter
water follows electrolytes

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12
Q

what are the side effects of furosemide?

A

dehydration
azotemia
hypokalemia
hypochloremia
hyponatremia
metabolic alkalosis
vomiting, pancreatitis, blood dyscrasia
deafness with rapid IV injections

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13
Q

what is pimobendan?

A

calcium sensitizer: inotropic
phosphodiesterase III inhibitor: vasodilator and inotropic

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14
Q

what is pimobendan approved for?

A

CHF due to MMVD
CHF due to DCM

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15
Q

what are the side effects of pimobendan?

A

uncommon:
diarrhea
tachycardia or arrhythmia
increased excitability

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16
Q

when do we use pimobendan in cats?

A

with CHF and no left ventricular outflow tract obstruction

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17
Q

what are the effects of digitalis glycosides?

A

positive inotrope
vagomimetic effect
reduced sympathetic output
improved baroreceptor function

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18
Q

how is digoxin eliminated?

A

renal

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19
Q

what are the electrocardiographic changes with digitalis glycosides?

A

slowed heart rate
prolonged P-R interval or AV block
shorted QT interval
ST segment changes
junctional or ventricular arrhythmias

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20
Q

what are the main clinical uses of digoxin?

A

treat supraventricular arrhythmias
treat recurrent syncope in dogs with MMVD
treat congestive heart failure

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21
Q

what are the signs of digitalis intoxication?

A

anorexia, lethargy, depression
vomiting and diarrhea
cardiac arrhythmias

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22
Q

what are the class IV antiarrhythmic drugs?

A

diltiazem
amlodipine

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23
Q

what are the current recommendation for treatment of stage C heart failure?

A

furosemide or torsemide as needed
pimobendan
angiotensin-converting enzyme inhibitor
spironolactone

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24
Q

what is an ACE inhibitor helpful for with CHF?

A

improves clinical signs
improved survival or time until worsening CHF

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25
Q

what is nitroglycerin?

A

venous vasodilator
also dilates coronary arteries

26
Q

what is amlodipine?

A

calcium channel blocker

27
Q

what is sodium nitroprusside?

A

balanced vasodilator

28
Q

what are the side effects of sodium nitroprusside?

A

hypotension
GI side effects
cyanide intoxication

29
Q

what are some thiazide diuretics?

A

hydrochlorothiazide
chlorothiazide

30
Q

what are the effects of epinephrine?

A

positive inotropic effect
positive chronotropic effect
significant arrhythmogenesis
dramatic rise in blood pressure

31
Q

what are the effects of norepinephrine?

A

positive inotropic effect
positive chronotropic effect
significant arrhythmogenesis
rise in blood pressure

32
Q

what is isoproterenol?

A

positive inotrope

33
Q

should you give beta blockers if there are active congestion signs with CHF?

A

no

34
Q

what does chronic sympathetic activation in CHF lead to?

A

arrhythmogenic
increase heart rate
vasoconstriction
stimulate renin release
cardiomyotoxic
promote myocardial fibrosis/cardiac remodeling

35
Q

what does sympathetic blockade in CHF do?

A

improves left ventricle function (ejection fraction)
blunts cardiac remodeling
improves quality of life (human)
prolongs survival and event-free survival (human)

36
Q

what does an angiotensin receptor blocker and neprilysin inhibitor do?

A

vasodilation, Na excretion (ANP, BNP, urodilation)
block negative effects of angiotensin II

37
Q

what are some SGLT2 inhibitors?

A

empagliflozin
bexagliflozin
velagliflozin

38
Q

what does it mean that furosemide is a high ceiling diuretic?

A

wide dose range

39
Q

what is the dose of furosemide for mild CHF?

A

2 mg/kg

40
Q

what is the dose of furosemide for advanced CHF?

A

up to 4 mg/kg

41
Q

what do retrospective studies on pimobendan in cats suggest?

A

cats tolerate pimobendan well
doses same in dogs and cats
maybe live longer from CHF

42
Q

what are digitalis glycosides derived from?

A

foxglove plant

43
Q

how is digitoxin eliminated?

A

liver

44
Q

how is digoxin dosed?

A

conservatively

45
Q

what can predispose an animal to digitalis intoxication?

A

renal insufficiency
hypokalemia
hypomagnesemia
reduced skeletal mass
advanced age
dosing without consideration of ascites
other drug interactions

46
Q

what can diltiazem be used to treat?

A

supraventricular tachycardia
atrial fibrillation
hypertrophic cardiomyopathy
coronary vasodilation

47
Q

what are the side effects of class IV antiarrhythmics?

A

excessive negative chronotropism
negative inotropism
excessive vasodilation

48
Q

why do we use ACE inhibitors with systemic hypertension?

A

reduces blood pressure
reduces hypertensive events

49
Q

what are the possible side effects of ACE inhibitors?

A

hypotension
azotemia
renal failure
GI side effects
cough

50
Q

what do spironolactone and eplerenone do?

A

aldosterone antagonists: conserve potassium, mild diuretic effect, restores baroreceptor function toward normal

51
Q

which loop diuretic has potassium sparing effects?

A

torsemide: mild

52
Q

what do venous vasodilators do?

A

reduce preload

53
Q

what do arterial vasodilators do?

A

reduce afterload: increase LV forward flow and hopefully less mitral regurgitation

54
Q

what do thiazide diuretics do?

A

inhibit sodium and chloride absorption in the distal tubule
weaker diuretic

55
Q

what are the downsides to beta-blockers?

A

acutely negative inotropes
benefits take 2-3 months to accrue
QOL and euthanasia wildcard

56
Q

what does neprilysin do?

A

cleaves natriuretic peptides
breaks down angiotensin II, endothelin

57
Q

when should you use furosemide as a CRI?

A

refractory emergency pulmonary edema

58
Q

what is the therapeutic range of digoxin concentrations?

A

0.8-2 ng/ml
toxic: >2.5 ng/ml

59
Q

what does angiotensin II cause?

A

vasoconstriction
release of aldosterone
increases thirst
stimulate ADH release
sympathetic stimulation

60
Q

how can sodium nitroprusside be used?

A

as CRI
for severe pulmonary edema

a. cardiovascular pathophysiology (35 decks)

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