chap 23 Treatment of Heart Failure

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cdsack
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75036
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chap 23 Treatment of Heart Failure
Updated:
2011-03-24 18:23:02
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Pharmacology
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drugs affecting cardiovascular system
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  1. automaticity
    spontaneaous depolarization (contraction) of heart cells
  2. cardioglycosides
    class of drugs, most commonly derived from the foxglove plant that have the ability to alter cardiovascular function. Digitalis is representative of this class of drugs
  3. digitialization
    process of rapidly increasing the initial dose of digoxin until the therapeutic dose is achieved
  4. ejection fraction
    percentage of blood ejected from the left ventricle with each heart beat
  5. heart failure
    clinical syndrome in which the heart is unstable to pump blood at a rate to meet body's metabolic needs
  6. natriuretic peptides
    hormones that play a role in cardia homeostasis
  7. positive inotropic effect
    increase the force of myocardial contractions
  8. stroke volume
    equal to amount of volume ejected by the left ventricle during each cardiac contraction minus the vloume in the ventiricle at the end of systole
  9. heart failure primarily affects the elderly affecting more that 10% of the populations over 50 years compared to 1% under the age of 50.
  10. up to age 75, the prevalence of heart failure is higher in men, but after age 75, the prevalence is higher in women
  11. disease, lifestyle, and drugs can contribute to the onset or aggravation of heart failure
  12. kidney dysfunction, bradyarrythmia, tachyarrythmia, pulmonary embolism, HIV/AIDS, and myocardial infarction contribute to heart failure
  13. heart failure can be worsened by lack of physical activity, and excessive alcohol and salt consumption
  14. NSAIDs worsen edema, and interfere with the drugs used to treat heart failure (e.g., ACEIs)
  15. heart failure may affect left side, right side, or both sides of heart
  16. left-sided heart failure reduces the volume of O2 and nutrient-rich blood pumped from the left ventricle to the reast of the body
    swelling in legs, ankles, fatigue

    fluid accumulation resulting in weight gain and increased urination
  17. right-sided failure reduces capacity of the heart to pump blood to the lungs
    fluid backs up (venous congestion) and cause pulmonary edema and shortness of breath

    BP increases
  18. heart failure classified as systolic heart failure (SHF) or diastolic heart failure (DHF)
    choice of drug therapy is influenced by whether the patient has SHF or DHF
  19. four stages of heart failure
    • stage A: high risk for developing heart failure
    • stage B: structural changes without symptoms
    • stage C: symptomatic
    • stage D: advanced structural heart disease plus heart failure symptoms
  20. in SHF, left ventricle contractions are reduced causing a decrease in the vol of blood ejected from the ventricles (stroke volume)
    results in reduced CO
  21. in DHF, stroke volume is reduced because the left ventricle is unable to accept a sufficient volume of blood during diastole
    CO is reduced, causing:

    • fatigue
    • dyspnea
    • pulmonary hypertension
  22. compensatory mechanisms are "switched on" when the heart function fails, RAAS attempt to satisfy the metabolic needs of the body and to reduce elevated BP
    RAAS activation results in increase of blood vloume and CO
  23. natruietic peptides are hormones that also play a role in cardia physiology, their release is also a compensatory mechanism in heart failure
  24. Natriuretic peptidesare released.–Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) promote sodium and water elimination, vasodilation, and diastolic relaxation.
  25. chronic SNS increases HR
  26. most treatments used in heart failure focus on treating symptoms, underlying causes, and factors that worsen heart failure
  27. many of the same drugs adminstered in the treatment od hypertension are also used in the treatment of heart failure
    β-blockers, ACEIs, ARBs, diuretics, aldosterone antagonists
  28. cardioglycosides are the oldest class of drugs in the treatment of heart failure
  29. Statins are also administered in the treatment of heart failure
  30. according to DIG studies, digitalis fails to increase survival in patients with heart failure
  31. digoxin may actually increase mortality in women
  32. digoxin should be administered with ACEIs, diuretecs, and or β-blockers
  33. cardioglycosides (e.g., digoxin) have a positive inotropic effect on the heart
    they increase the force of mycardial contractions

    the greater force of contractions increases cardiac output
  34. digoxin ADRs
    • Diarrhea
    • Constipation
    • Nausea and vomiting
    • Fatigue
    • Weakness
    • Visual disturbances (altered color perception, hazy vision)
    • Photophobia
    • Impotence
    • Gynecomastia
  35. Digoxin increases cardiac output and decreases compensatory sympathetic activity. which results in slowed heart rate
    It is the only commercially available cardioglycoside.
  36. Signs of digitalis toxicity are arrhythmia, dizziness, headache, convulsions, delusions, and coma.
  37. patient must be monitored carefully for signs of digitalis tocicity because digoxin has a narrow TI,
    initail dose should be half, followed by 1/4 in 8-12 hrs, and final 1/4 about 8-12 hrs later
  38. bioavailability of digoxin varies by manufacturer, so switching between manufacturers is not recommended
    food also can decrease digoxin absorption
  39. digoxin not recommended for treatment of DHF in men or women, especially if sinoatrial or AV bloack is present
  40. diuretics are used to treat volume overloads
    they also lower BP
  41. loop and thiazide diuretics can cause hypokalemia, which can cause ventricular arrythmias and increase the effects of digoxin leading to toxicity
  42. β-blockers reduce HR, lower PR, and decrease the workload of your heart, reduce left ventricular hypertrophy
  43. studies show that β-blockers can lower the risk of mortality associated with congestive heart disease
  44. β-blockers block excess sympathetic stimulations induced by heart failure
  45. CCBs may be used in the treatment of DHF because they can control HR, lower BP, and treat ischemia-- risk factors for congestive heart failure (CHF)-- and reduce left ventricular hypertrophy
  46. CCBs should not be administered for the treatment of SHF because they can make ventricular contractions worse, further reducing cardiac output
  47. ACEIs have been shown to reduce mortality rate (prolong life).
  48. ACEIs reduce left ventricular hypertrophy, improve diastolic filling, increase CO, reduce peripheral vascular resistance
  49. ARBs are also administered for the treatment of heart failure
    they improve exercise tolerance and diastolic fillling in patients with DHF
  50. administration of statins is associated with increased survival in patients with heart failure with ischemic disease buit increased mortality when total cholesterol levels are low and ischemic disease is absent
  51. isosorbide dinitrate and hydralazine are used in combination for the treatment of heart failure for their vasodialating effects
    together they decrease mortality and effectively reduce cardiac congestion

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