Preload
blood flow force that stretches the ventricle at the end of diastole.
Afterload
resistance to ventricle ejection of blood, which is cause by opposing pressures in the aorta and systemic circulation.
Heart Failure Right sided
Blood backs up in periphery
Heart Failure Left Side
Blood backs up in lungs.
Cardiac Output
4-8 liters/min
Cardiac Glycosides -Positive inotropic
Increases myocardial contractility
Cardiac Glycosides- Negative chronotropic
Decreases heart rate
Cardiac Glycosides- Negative dromotropic
Decreases conduction
Cardiac Glycosides- increase stroke volume
increases cardiac output.
ACC
American College of Cardiology
AHA
American Heart Association
Stage 1 HF
High risk for HF without symptoms or structural disease.
Stage 2 HF
Some levels of cardiac changes (e.g. decrease ejection fraction without symptoms of heart failure.)
Stage 3 HF
Structural heart disease with symptoms of HF (e.g. fatigue, SOB, edema, physical activity.
Stage 4 HF
severe structural heart disease and marked symptoms of HG at rest.
Hf- Nonpharmacologic treatment
Limit salt intake, Limit or avoid alcohol intake, stop smoking, decrease saturated fact in take, Preform mild exercise possible
HF Laboratory tests ANP
Atrial natriuretic peptide- an elevated ANP may confirm heart failure. Reference value is 20-77 pg/ml. ANH is secreted from the atria of the heart.
Brain Natriuretic Peptide BNP
an elevated BNP helps to differentiate that dyspnea is due to HF rather than lung dysfunction. Reference value desired value is less than 100pg/mL
Cardiac Glycosides Digoxin
GIve once a due
Therapeutic level 0.5 to 2.0 ng/mL
Pediatric doses are usually ordered in mcq in elixir form
Digitalis toxicity (symptoms)
Anorexia, diarrhea, nausea, vomiting, BRADYCARDIA, dysrhthmias, VISUAL DISTURBANCES
Antidote for digitalis toxicity
DIGOXIN IMMUNE GAB (OVINE, DIGIBIND)
Drug interactions Diuretics/digitalis
promote the loss of potassium result is hypokalemia which increases the effect of digitalis resulting in toxicity.
Drug interactions Antacids/Digitalis
decreases digitalis absorption if taken at the same time.... should stager
Drug interactions Herbal Ginsing/Digitalis
may falsely elevate digoxin levels
Drug interactions Herbal St. Johns Wort/digitalis
decreases absorption of digoxin
Drug interaction Herbal Psyllium (metamucil)
decreases digoxin absorption
Drug interaction HerbalHawthorn/Digoxin
increases the effect of digoxin
Drug interaction Herbal aloe/digoxin
may increase risk of digitalis toxicity
Drug interaction Herbal ma-huang or ephedra/ Digoxin
increases risk of digitalis toxicity
PHOSPHODIESTERASE Inotropic agents DO?
Increase myocardial contractility, Administered IV for no more than 48-72 hrs. MONITOR ECG
Phosphodiesterase
severe cardiac dysrhythmias might result from use, monitor ECG and cardiac status
Normal Potassium levle
3.5-5.3mEq
Other agents used to treat HF
Vasodilators, Angiotensin-concerting enzyme (ACE) inhibitors, Angiotensin II receptor blockers (ARB), Diuretics, Certain beta blockers, Atrial natriuretic peptide hormone.
Angiotensin II receptor blockers (ARB)
Valsartan, DIOVAN
Diuretics
Spironolactone (Aldactone)
Beta blockers
Carvedilol (COREG)
Metoprolol (TOPROL-XL)
Atrial natriuretic peptide hormone
Nesiritide (NATRECOR)
Antianginal Drugs
Nitrates, Beta Blockers, Calcium channel blockers, k
Antianginals Nitrates Side effects
HYPOTENSION, HEADACHE, dizziness, reflex tachycardia, DECREASE EFFECTS OF HEPARIN
Antianginals-Beta Blockers
Atenolol (TENORMIN), metoprolol (LOPRESSOR), nadolol (CORGARD), propranolol HCl (INDERAL)
Antianginals- Beta Blockers (action)
decrease hear rate, myocardial contractility. which reduces oxygen need and anginal pain
Antianginals- Beta Blockers (Side effects/Adverse reactions)
Bradycardia, hypotension,
Bronchospasm
Depression
Sexual dysfunction.
antianginal drugs calcium channel blockers
Amlodipine (NORVASC), DIltiazem HCl (CARDIZEM), felodipine (Plendil), Nicardipine HCl(Cardene), Nifedipine (PROCARDIA), Verapamil HCl (Calan, Isoptin)
antianginal drugs calcium channel blockers (side effects)
HEADACHE, DIZZINESS, FLUSHING, HYPOTENSION, reflex tachycardia.
Antidysrhythmic Drugs Mechanism of action
to restore the cardiac rhythm to normal.
Antidysrhythmic Class I
Sodium channel blockers
1a:slow conduction, prolongs repolarization
1b: slow conduction, shortens repolarization
1c: prolonged conduction with little/no effect on repolarization
Antidysrhythmic Class II
Beta-adrenergic blockers acebutolol (SECTRAL) MAY INCREASE POTASSIUM
antidysrhythmic Class III
prolongs repolarization
antidysrhythmic Class IV
Calcium channel blockers
antidysrhythmic Other
Phenytonin, digoxin, ibutilide fumarate
Lidocaine (ZYLOCAINE) used for acute ventricular dysrhythmias following MI and cardiac surgery.