Heart Failure

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  1. is HF often reversible or irreversible
    often irreversible
  2. what type of episodes is HF punctuated by
    episodes of acute decompensation
  3. etiology of HF (acute exacerbations)
    • exx NA+ or fluid intake
    • poor compliance w meds
    • concominant non cardiac illness
  4. what is the primary cause of HF
    • LV contractile dysfunction
    • ex. cardiogenic failure
  5. other causes of HF
    • uncontrolled HTN
    • valvular heart disease
    • absence of contractile dysfunction
  6. what does first response Frank-Starling mechanism do
    increase SV which is a direct response to increased preload
  7. what is the 2nd response to compensatory HF
    cardiac remodeling and hypertrophy of the myocardium
  8. what is the third response to compensatory HF
    activation of neuro hormonal systems which modulates the IV volume and vaso tone to maintain O2 delivery to critical organs
  9. what is the 3 clinical approaches to management of HF
    • preload reduction
    • afterload reduction
    • inotropic agents
  10. what agents are used for preload reduction
    • diuretics
    • spironalactone
    • nitrates (venodilators)
  11. what agents are used for afterload reduction
    • ACEI
    • beta antagonists
    • vasodilators
  12. what inotropic agents are used for mgmt of HF
    • cardiac glycosides
    • PDEIs
    • adrenergic agents
  13. what are diuretics very effective at reducing
    congestive symptoms
  14. RALES study
    spironolactone decreases mortality by 30 percent when used in combination with standard therapy
  15. MOA of venodilators
    • increase venous capacitance
    • decrease venous return
    • decrease LV chamber volume
    • decrease LV diastolic pressure
  16. effect of venodilators
    decrease preload
  17. effects of ACEI
    • decrease afterload and preload
    • decrease impedance to LV ejection
    • increase stroke volume
    • increase GFR
    • increase Na/H2O excretion
  18. consensus trial
    ACEIs have significant impaact on survival in patients with HF
  19. beta blockers increase survival in HF patients by:
    • inhibition of renin release
    • attenuation of cytotoxic and signaling effects of catecholamines
    • prevention of ACS
  20. what is Hydralazine?
    a direct acting vasodilator
  21. what does vasodilation lead to?
    SVR and decrease afterload
  22. adverse effects of vasodilators that limits its clinical use
    • reflex increase HR
    • tachyphylaxis
    • drug induced lupus
  23. who are vasodilators reserved for
    pts who cannot tolerate ACEIs
  24. AHETT trial
    vasodilators show great benefit when combined with nitrates
  25. sympathomimetic amines MOA
    • B1 stimulation (inotropism)
    • B2 stimulation (vasodilation/ decr afterload)
  26. PD inhibitors MOA
    • inhibit the degredation of cAMP
    • arterial vasodilation
    • venodilation
  27. what are PD inhibitors reserved for
    short term treatment of patients with ADHF
  28. what is the caution of PD inhibitor long term use
    increased mortality
Card Set:
Heart Failure
2013-03-30 02:26:00
Dr Oyekan

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