| A | B |
|---|
| heart failure characterized by | inadequate tissue perfusion & volume overload |
| causes of CHF | htn, mi, valvular heart disease, cad, cong. heart disease, dysrhythmias, aging of myocardium |
| cardiac remodeling | ventricles enlarge, hypertrophy, increased wall stress, decreased lvef, fibrotic changes & cell death, decreased cardiac output |
| cardiac remodeling driven by | neurohormonal system (sympathetic nervous sytem & renin/angiotensin/aldoesterone system) |
| adaptations to reduce cardiac output | 1) incrased sympathetic tone 2) increased water retention |
| increased sympathetic tone causes | increase HR, increase contractility, increase venous & arterial tone |
| water retention in CHF caused by | activation of renin/angiotension sytem with increased levels of aldosterone & angiotensin 2 |
| clinical manifestations of CHF | SOB, tachycardia, edema, jugular vein distention, hepatomegaly, |
| drugs used to treat CHF | diuretics, drugs that inhibit RAAS, beta blockers, digxoin, inotropic agents, vasodilators |
| how diuretics work | reduce volume, dec. venous & arterial pressure, decrease peripheral & pulmonary edema, decrease cardiac dilation |
| how drugs that inhibit RAAS work | decrease afterload & preload (dilation of art. & veins), suppression of aldosterone release |
| how beta blockers help in heart failure | can protect from excessive sympathetic stimulation, avoid dysrythmias |
| side effects of ACE I | cough, renal failure, hyperkalemia, hypotension fetal injury, angioedema, rash |
| drugs that affect RAAS & used in CHF | ACE I, ARB's, aldosterone antagonists |
| how aldosterone makes heart failure worse | renal retention of sodium in exchange for excretion of potassium, causes cardiac remodeling, cardiac fibrosis, activates sympathetic nervous system, promotes vascular fibrosis, promotes baroreception dysfunction |
| side effects of beta blockers | fatigue, bradycardia, hypotension, fluid retention |
| how digoxin & cardiac glycosides work in CHF | positive inotrophic effects, increases myocardial forces, affects neurohormonal systems, |
| digoxin side effects | severe dysrhythmias, cardiotoxity, dig toxicity, anorexia, nausea, vomiting, fatigue |
| digoxin comes from | digitalis (Foxglove plants/flowers) |
| second line agent in CHF | digoxin |
| what competes with digoxin for binding? | potassium |
| potassium | this must be kept in a normal range when using digoxin |
| effexts of digoxin that help in CHF | increased cardiac output, increased renal flow/urine output, decreases fluid retention, decreases heart rate |
| electrical effects of digoxin | increases responsiveness of SA node to acetylcholine; increases firing rate of vagal fibers |
| drug interactions with digoxin | diuretics causing hypokalemia, ACE I & ARBS (hyperkalemia); sympathomimetics because they increase contractility & heart rate, quinidine & verapamil (increase dig levels in blood), beta blockers (decrease contractility & heart rate) |
| NY Heart Failure Class I | no limitation of normal activity |
| NY Heart Failure Class II | slight limiation of normal activity; some dyspnea, angina or palpitations w/normal actifvity |
| NY Heart Failure Class III | marked limitations of nl activity; even mild activity produces sykmptoms |
| NY Heart Failure Class IV | symptoms at rest |
| ACC/AHA STage A | at high risk for heart failure, but withiout symptoms |
| ACC/AHA Stage B | structural heart disease, but without symptoms |
| ACC/AHA Stage C | structural heart disease, with prior or current symptoms |
| ACC/AHA Stage D | advanced structural heart disease w/marked symptoms at rest |
| ACC/AHA managment of CHF Stage A | risk reduction |
| ACC/AHA managment of CHF STage B | ACE I & beta blocker |
| ACC/AHA managment of CHF C | ACE I, beta blocker & diurectic |
| digoxin mechanism of action | inhibits the Na+/K/ATPase pump |
| two calcium channel blockers that lower heart rate | diltiazem & verapamil |
| Digibind works by | inactivating the digoxin by forming an antibody/antigen complex |
| diltiazem & verpamil | non dihydropyridine calcium channel blockers |
