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Chronic Heart Failure

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morauch630's version from 2017-12-09 16:17

Definitions

Question Answer
Cardiac output (CO)Volume of blood ejected from heart per unit of time
Calculate COCO=SV X HR
Stroke volumeVolume of blood ejected with each beat
AfterloadForce against which the ventricle must contract
PreloadAmount of blood going to the heart
Calculate BPBP = CO X SVR (systemic vascular resistance)
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Pathophysiology

Question Answer
As more stretch is applied to myocardial fibers, they will contract with greater force. This is known as the ________ law.Frank Starling
What side does HF usually originate?Left
Explain the pathophysiology of HFDecreased ability to pump into systemic blood circulation -> reflex sympathetic nervous system activation -> HTN -> increased myocardial contractile strength
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New York Heart Association Classification (NYHA) Functional classification

Question Answer
T/F the NYHA classification system identifies reason and type a person has HFF. JUST FUNCTIONALITY
Class 1Asymptomatic at rest or with ordinary activity; signs or symptoms with severe exercise
Class 2Comfortable at rest; signs or symptoms with ordinary exercise
Class 3Comfortable at rest; signs or symptoms with mild or minimal exercise
Class 4Signs or symptoms at rest
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Common precipitating factors

Question Answer
What are the common precipitating factorsPatient factors, Progression of cause, Increased cardiac workload, Medications that impair cardiac performance
Patient factorsAlcohol intake, Excessive fluid intake, Excessive salt intake, Increased stress, Weight gain
Progression of basic causeHTN, CAD,
Increased cardiac workloadArrhythmia, Electrolyte and acid-base abnormalities, Anemia, hypo- or hypervolemia, Infection
Medications that impair cardiac performanceAntiarrhythmics, BB, CCB, Digoxin, Corticosteriods, NSAIDS
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Treatment

Question Answer
Fluid retentionDiuretics
Which diuretics are used for fluid retentionFurosemide more effective than thiazides
T/F before starting an ACE or ARB you should start a diureticT. Add ACE and ARB after diuretic
Which medications should be in all pt with HF?ACE or ARB
T/F You don't need to check it pt is dehydrated before starting diureticF. Make sure patient is not dehydrated before starting
Which class can be added in all pt w stable HF (minimal fluid retention)beta-blockers
T/F spirolactone has been found to decrease mortalityT
Pt who can't tolerate ACE inhibitors can takeNitrates and hydralazine
May be useful in diastolic failureCCB
May worsen systolic failureCCB
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Cardiac Glycosides

Question Answer
Cardiac Glycoside mech of actionInhibition of the Na-K ATPase pump. Causes increased intracellular Na. Causes increased Na/Ca exchange leading to increased Ca in sarcoplasmic reticulum. Leads to activation of cardiac contractile proteins, actin and myosin. Causes increased force of contraction of cardiac muscle
Cardiac Glycoside effectsIncreased force of myocardial contraction. Depression of the SA node by stimulating vagal activity. Prolongation of the AV node conduction via vagal stimulation. Increased refractory period of AV node. Increased peripheral resistance
absorption60-80% oral absorption
metabolismVery little metabolism
excretionRenal excretion (Up to 75% unchanged)
half-lifeHalf-life of 36 hours
T/F Cardiac Glycosides are removed by dialysisF.
Cardiac glycoside cautionsrenal insufficiency, not bioequivalent, dose adjustments for thyroid disease, electrolyte imbalances
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lyte imbalances & effect on CG

Question Answer
Hypokalemiamakes myocardium more sensitive to digoxin, may decrease inotropic effect
Hypercalcemiapredisposes to digoxin toxicity, hypocalcemia may make digoxin ineffective
Hypomagnesiemiapredisposes to digoxin toxicity
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Containdications/Adverse effects of CG

Question Answer
Contraindicated inVentricular fibrillation, Ventricular tachycardia
MonitoringDigoxin levels. Electrolyte levels. Heart rate
What is the therapeutic Dig lvlTherapeutic level 1 – 2 ng/ml
Cardiac Glycosides – Adverse EffectsAnorexia, Nausea / vomiting, Abdominal discomfort, Headache, Weakness, Visual disturbances, Blurred vision, halo effect
Cardiac Glycosides – Adverse Effects, ArrhythmiasVentricular tachycardia, Multifocal PVCs, Atrioventricular block, Bradycardia, Nodal rhythms, Atrial fibrillation, Ventricular fibrillation
Signs of Cardiac Glycoside Toxicityfatigue, Anorexia, Weakness, Nausea, Arrhythmias, Diarrhea, Visual disturbances
Drugs That Increase Digoxin LevelsAmiodorone, Bepridil, Cylosporine, Indomethacin, Itraconazole, Macrolids, Propafenone, Quinidine. Spironolactone, Verapamil, Tetracycline
Those that decrease digoxin levelsAntacids, Antineoplastics, Activated charcoal, Cholestyramine (Questran)‏, Colestipol (Colestid)‏, Kaolin/pectin, Metoclopramide (Reglan)‏
Cardiac Glycosides – NamesDigoxin (Lanoxin, Digitek, Lanoxicaps)‏ PO, IV
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