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C & R II - wk1 > treatment of heart failure > Flashcards

treatment of heart failure Flashcards

1
Q

what is symptomatic tx of heart failure

A
  • improve systolic and diastilic heart function
  • eliminate aggravating conditions (arrhythmias, infection, hypertension, electrolyte abnormalities)
  • control signs of congestion
  • avoid drug adverse effects
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2
Q

how to manage systolic and diastolic function of myocardium

A
  • increase contractility
  • improve relaxation
  • minimize hypertrophy, fibrosis, remodeling
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3
Q

how to reduce cardiac work

A
  • reduce afterload
  • reduce tachycardia
  • control obesity
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4
Q

how to control congestion

A
  • reduce preload
  • manually drain pleural and abdominal effusion
  • reduce sodium intake
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5
Q

what is diastolic heart failure

A
  • feline hypertrophic cardiomyopathy (HCM)
  • excessive concentric hypertrophy
  • impaired diastolic relaxation
  • increased myocardial stiffness (decreased compliance)
  • normal systolic function
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6
Q

what is the consequense of increased myocardial stiffness

A
  • increased stiffness/decreased compliance
  • increases in volume (preload) cause increased diastolic pressure
  • increased venous pressure causes congestion
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7
Q

how do you reduce preload by relieving congestion

diastolic pressure in ventricle/atrium/veins

A

increase fluid excretion

  • loop diuretics: furosemide

increase venous capacitance

  • venous vasodilators: nitrates
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8
Q

what do you use to reduce preload and afterload

A

ACE inhibitors (in conjunction with furosemide)

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9
Q

what are the effects of ACEI

A
  • reduces afterload
  • makes it easier for heart to eject blood forward (better cardiac output)
  • reduces preload
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10
Q

what is myocardial oxygen demand (MVO2)

A
  • proportional too wall stress x HR
  • wall stress is proportional to systolic blood pressure
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11
Q

how do you reduce myocardial work

A
  • lengthen diastolic filling time
  • reduce obstructions to flow (decrease HR, contractility)
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12
Q

what drugs do you use to slow HR and increase diastolic filling time

A
  • beta-adrenergic receptor blockers - decrease sympathetic tone - sinus node
  • Ca2+ channel blockers - decreases Ca2+ dependent depolarization - sinus node
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13
Q

what are the side effects of diuretics

A
  • hypovolemia
  • electrolyte abnormalities
  • pre-renal azotemia
  • acute kidney injury
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14
Q

what are the side effects of ACEI

A
  • kidney injury
  • hypotension
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15
Q

what are the side effects of beta-blockers and Ca-blockers

A

bradycardia

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16
Q

what is the FOND protocol

A
  • Furosemide
  • Oxygen
  • Nitroprusside or nitroglycerine
  • Dobutamine, dopamine, digoxin
17
Q

FOND

what is furosemide

A
  • Lasix
  • potent, rapid acting, IV/IM/SQ
  • short half life
  • monitoor urine production
  • monitor hydration status
  • monitor renal function
  • consider constant rate infusion
18
Q

FOND

what is oxygen

A
  • if SaO2 <90%
  • oxygen cage: FiO2 = 40-60%
  • intranasal O2: 100% O2
  • positive pressure ventilation
19
Q

FOND

what is nitroprusside

A
  • produces nitric oxide (NO)
  • potent mixed vasodilator
  • venouos vasodilator: reduce preload
  • arterial vasodilator: reduce afterload
  • very short half life
  • CRI: 2-15 ug/kg/min
  • dilute in 5% dectrose, protect from light
  • monitor blood pressure to avoid hypotension
20
Q

FOND

what is dobutamine infusion

A
  • sympathomimetic (synthetic B1-agonist, increases contractility)
  • very short half life (CRI: 2.5 to 20 ug/kg/min)
  • dilute in 5% dextrose
  • side effect: tachycardia (monitor HR and rhythm)
  • relatively expensive compared to dopamine
21
Q

FOND

what is dopamine infusion

A
  • endogenous B-agonist
  • also binds dopamine and a-receptors
  • very short half life (CRI 2-8 ug/kg/min, dilute in 5% dextrose)
  • side effects: vasocontriction at high doses, tachycardia
  • monitor HR & rhythm
22
Q

what is an alternative to FOND

A
  • Furosemide
  • Oxygen
  • ACEI
  • Pimobendan

FOAP

23
Q

what is pimobendan

A
  • calcium sensitizer (increased contractility - positive inootrope)
  • phosphodiesterase inhibitor (atrial vasodilator)
  • “inodilator”
24
Q

what are the adverse effects of ACEI

A
  • renal dysfunciton
  • hypotension
  • hyperkalemia
25
Q

what is the limitation of ACEI therapy

A
  • incomplete suppression of RAAS
  • “adosterone breakthrough (ABT)”

C & R II - wk1 (13 decks)

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