Heart Failure

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Heart Failure
2013-04-13 10:32:58
Dr Oyekan

PT II exam III
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  1. primary cause of HF
    LV contractile dyfunction (systolic HF)
  2. majority of HF cases are attributable to
  3. other causes of HF
    • uncontrolled HTN
    • valvular heart disease
    • hypovalemia
    • abnormal cardiac rhythm
    • shock
  4. 1st response
    • Frank Starling Mechanism
    • increase SV- a direct response to inc preload
  5. 2nd response
    full cardiac remodeling and hypertrophy of the myocardium
  6. 3rd response
    activation of neuro hormonal systems which modulate intravascular volume and vasomotor tone to maintain O2 delivery to critical organs
  7. RALES study
    spironolactone decrease mortality by 30% when used in combination with standard tx
  8. CONSENSUS trial
    ACEI have significant impact on survival in HF pts
  9. mechanisms by which BBs increase survival in HF pts
    inhibition of renin release

    attenuation of cytotoxic and signaling effects of catecholamines

    prevention of ACS
  10. hydralazine is a
    direct acting vasodilator
  11. vasodilation leads to
    decreased SVR and afterload
  12. AE of vasodilators
    • reflex tachycardia
    • tachyphylaxis
    • drug induced lupus
  13. vasodilators are reserved for
    HF pts who cannot tolerate ACEIs
  14. AHETT trail
    vasodilators show great benefit when combined with nitrates
  15. cardiac glycosides MOA
    • inhibition of Na+ K+ ATPase
    • leads to increased intracellular Na+
    • leads to activation of NA/Ca exchange
    • causes an increase in Ca++ influx
    • which leads to myocardial contractility
  16. sympathomimetic amines MOA
    • B1 stimulation--positive inotropism
    • B2 stimulation--vasodilation--decrease afterload
  17. PDEI MOA
    • inhibition of cAMP degredation
    • increases intracellular Ca++ (+ve inotropism)
    • arterial vasodilation (decreased afterload)
    • venodilation (decreased preload)
  18. clinical use of PDEIs
    short term treatment of pts with acute DHF
  19. caution with PDEIs
    long term use increases mortality