Perfusion Part 6 - Flashcards
Why is chronic stress an issue?
Chronic stress = chronic cortisol secretion = no purpose for extra cortisol = adrenal insufficiency (overall depletion due to perceived overproduction).
Cortisol _____ _____ glycogen to prevent ______.
breaks down; starvation.
What are 4 common signs & symptoms of adrenal insufficiency?
- Salt cravings due to a excess Na+ excretion.
- Fatigue due to lack of glycogen breakdown.
- Hypoglycemia (post-exercise) due to lack of refill mechanism.
- Hyponatremia.
What is the danger of a non-physician monitored Keto diet?
Metabolic acidosis: breakdown of adipose tissue for energy > triglycerides > fatty acids > decline in cellular function/necrosis
Why are diabetics prone to metabolic acidosis?
They lack insulin to break down glucose, so fatty acids are used for energy.
What’s the difference between primary and secondary pulmonary hypertension?
Primary: related to organ function.
Secondary: due to diagnosed disease.
What do we use to treat pulmonary hypertension? What route of admin is used?
Nipride (DAV): endotracheal for pulmonary vasodilation.
What is a potential secondary injury that can result from pulmonary hypertension?
Cor pulmonale (right-sided heart failure) due to backlog affecting the heart.
What is the difference between an MI and heart failure (HF)?
MI: injury to cardiac cells due to lack of O2.
HF: ANY condition decreasing the heart’s ability to pump enough blood to meet metabolic demands.
What’s the difference between systolic & diastolic HF?
Systolic: contraction is affected due to muscle atrophy.
Diastolic: filling is affected due to hypertrophy decreasing chamber space.
List some major risk factors for HF.
Basically anything that can lead to decreased functional ability. CAD HTN Large MI Cardia tamponade Electrolyte imbalance (K+, Ca2+ for contraction) Arrhythmias (a. fib, bradycardia) Cardiomyopathy Diabetes Vascular dysfunction
What regulates HR, CO & BP? (4)
CNS
ANS (peripheral vascular resistance & BV)
Baroreceptors
Hormonal regulation of BP (ex: aldosterone, ADH, renin-angiotensin)
Where does the back-up occur in right-sided heart failure?
Systemic circulation (specifically: venous system).
Right-sided heart failure causes ______ pressure to build, leading to fluid shifting _________.
capillary; into cells.
What are 3 symptoms of right-sided heart failure?
- Peripheral edema (pitting due to fluid accumulation)/weight gain.
- Organ congestion: liver, renal, GI.
- Ischemia: LoC changes, fatigue.
Where does the back-up occur in left-sided heart failure?
Pulmonary circulation.
What are 3 signs & symptoms of left-sided heart failure?
- Pulmonary edema: hypoxia, hypoxemia, cyanosis.
- SoB, crackles on auscultations & coughing.
- Exercise intolerance.
Briefly describe how SNS activation leads to compensation and ultimately, worsening of CO.
Induces muscle hypertrophy of surrounding smooth muscle/fibroblast (not heart cells) > decrease in ventricle volume > CO decreases more.
What 2 substances does the SNS release to initiate compensation?
- Endothelial enzymes.
2. Cytokines (inflammatory mediators).
What are our 3 goals for pharmacotherapy of HF?
- Decrease cardiac workload.
- Increase O2 supply.
- Increase contractility.
What are 3 ways to either decrease cardiac workload or increase O2 supply?
- Decrease preload/afterload (decrease blood volume & vasodilate).
- Decrease HR.
- Oxygenate the patient.
Which 5 classes of drugs can we use to decrease preload/afterload or decrease HR to targets?
- Diuretics (ex: Spironalactone): decreases preload.
- ACE inhibitors.
- Adrenergic antagonists (receptor-specific).
- DAVs.
- Calcium channel agonists/blockers.
Besides decreasing preload/afterload, what is another benefit of using diuretics to treat HF?
Decreases sodium retention.
Which 3 drug classes are used to increase contractility?
- Cardiac glycosides.
- P inhibitors.
- Adrenergic agonists.
