CONGESTIVE CARDIAC FAILURE. Dr.T.Rajathilagam, M.D., S.R.M. Medical College
|
|
- Aubrie Dalton
- 6 years ago
- Views:
Transcription
1 CONGESTIVE CARDIAC FAILURE Dr.T.Rajathilagam, M.D., S.R.M. Medical College
2 HEART FUNCTIONS Your heart is an amazing powerhouse that pumps and circulates 5 or 6 gallons of blood each minute through your entire body.
3 CARDIAC MUSCLE Excitability- depolarisation Contractility-Contraction & relaxation Automaticity- spontaneous electrical impulses
4
5 CARDIAC ACTION POTENTIAL Phase 0 (fast upstroke)- rapid depolarisation, sodium channels Phase 1 (partial repolarisation)- efflux of potassium ions Phase 2 (plateau)- slow entry of calcium ions Phase 3 (repolarisation)- efflux of potassium ions Phase 4 (resting phase)
6
7 HEART FAILURE Unable to pump sufficient blood to meet the metabolic demands Impaired ability to adequately fill &/or eject blood CONGESTIVE dyspnoea, edema Compensatory mechanisms- Increased sympathetic activity- heart rate & force of contraction, vasoconstriction Activation of RAS- peripheral resistance, sodium & water retention Myocardial hypertrophy
8 LV Dysfunction causes Decreased cardiac output Decreased Blood Pressure and Decreased Renal perfusion Stimulates the Release of renin, Which allows conversion of Angiotensin to Angiotensin II. Angiotensin II stimulates Aldosterone secretion which causes retention of Na+ and Water, increasing filling pressure
9 CHRONIC HEART FAILURE : NEUROHORMONAL STATUS SNS RAAS Vasopressin Endothelin-1 DILATATION CONSTRICTION Natriuretic peptides Nitric oxide Vasodilatory PGs Adrenomedullin
10 CONGESTIVE CARDIAC FAILURE RISK FACTORS Smoking High BP High Cholestrol Obesity Some of the risk factors for heart disease include smoking, high blood pressure, high cholesterol, diabetes, and obesity.
11 CONGESTIVE CARDIAC FAILURE RISK FACTORS Lack of Exercise Unhealthy Diet Stress TYPE A Personality
12 PATHOGENESIS OF HEART FAILURE Ischemia Hemodynamic overload Symptoms LV EF LV Remodeling Pump Failure Genetics Inflammation Arrhythmias Asymptomatic Symptomatic
13 CLINICAL PRESENTATION OF HEART FAILURE Due to excess fluid accumulation: Dyspnea (most sensitive symptom) Edema Hepatic congestion Ascites Orthopnea, Paroxysmal Nocturnal Dyspnea (PND) Due to reduction in cardiac ouput: Fatigue (especially with exertion) Weakness
14 CONGESTIVE CARDIAC FAILURE - SYMPTOMS Left-Side Heart Failure: Fatigue and shortness of breath (dyspnea) are the first symptoms. They are caused by fluid in the lungs. Fluid retention. Patients may complain of leg or abdominal swelling. Loss of muscle mass. Over time, patients may lose muscle weight due to low cardiac output. Wheezing or cough. Patients may have asthma-like wheezing or a dry hacking cough that occurs a few hours after lying down, but then stops after the patient sits up.
15 CONGESTIVE CARDIAC FAILURE - SYMPTOMS Right-Side Heart Failure: Fatigue. As with left-side heart failure, an early symptom of right-side (right-ventricular) failure is extreme tiredness.
16 CONGESTIVE CARDIAC FAILURE - SYMPTOMS Right-Side Heart Failure: Fluid accumulation. This first occurs in the feet, then the ankles and legs, and finally in the abdomen. The liver may also be enlarged. Weight gain. Although appetites are often depressed, patients with heart failure gain weight because they retain salt and water. Loss of muscle mass.
17
18 CONGESTIVE CARDIAC FAILURE - SYMPTOMS Besides chest pain (angina) and shortness of breath, some other common symptoms of heart disease include jaw pain, back pain, and heart palpitations
19 Low output failure- IHD, hypertension, valvular & congenital heart diseases High output failure- anemia, thyrotoxicosis Edema, dyspnoea, hepatomegaly, urine output, fatigue
20
21
22
23 Ventricular dysfunction limits a patient's ability to perform the routine activities of daily living
24
25 THERAPEUTIC GOALS Symptom relief Slow disease progression Improve survival
26 CONGESTIVE CARDIAC FAILURE - TREATMENT Dietary Changes Lifestyle Changes Exercises Medications
27 DRUGS TO RELIEVE SYMPTOMS Inotropes- Digoxin, Dobutamine/Dopamine, Amrinone Diuretics- Furosemide, Thiazides Vasodilators- ACEI, ARBs, directly acting Beta blockers- metoprolol, bisoprolol, carvedilol SLOW DISEASE PROGRESSION & IMPROVE SURVIVAL ACEI/ARBs Beta blockers Aldosterone antagonist- Spironolactone
28 INOTROPES- CARDIAC GLYCOSIDES Digitalis purpura, D.lanata (Foxglove) Increase myocardial contraction & output No increase in oxygen consumption & heart rate Improves cardiac efficiency Digitoxin, Digoxin, Ouabain
29 CARDIAC MUSCLE CONTRACTION
30 MECHANISM OF ACTION
31
32
33 HEART ACTIONS Positive inotropy ( force of contraction) Systole is shortened, diastole prolonged cardiac output HR, peripheral resistance, myocardial oxygen demand Electrophysiology- APD, ERP, slow AV conduction
34
35 ACTIONS BLOOD VESSELS Reflex sympathetic overactivity is withdrawn peripheral resistance Improved venous tone KIDNEY Diuresis CNS CTZ stimulation Confusion, disorientation, visual disturbances
36 PHARMACOKINETICS PARAMETERS DIGITOXIN DIGOXIN Oral absorption Very good (90-100%) PPB 95% 25% T1/2 5-7 days 40 hrs. Good (70-90%) Duration of action 2-3 wks 2-6 days Daily maintenance dose mg mg metabolism liver Renal excretion Used for maintenance Routine treatment & emergency
37 CARDIAC ADVERSE EFFECTS Arrhthymias- p.bigeminus, VES,VT, partial to complete AV block, VF, AES, AF, AFl STOP DIGOXIN Tachyarrhthymias- KCL 20m.mol/hr i.v. or oral Ventricular arrhthymias- Lignocaine i.v. Supraventricular arrhthymias- Propranolol i.v. or oral AV block- Atropine i.m. DIGOXIN ANTIBODY- Fab fragment (DIGIBIND), nonimmunogenic, effective in toxicity
38 ADVERSE EFFECTS EXTRACARDIAC GIT Anorexia, nausea, vomiting, abd.pain, diarrhoea CNS Fatigue, headache, confusion, restlessness, disorientation, visual disturbances
39 CONTRAINDICATIONS Hypokalemia Elderly, renal & hepatic disease children MI Thyrotoxicosis Hypothyroidism VT Myocarditis WPW syndrome
40 CHF THERAPEUTIC USES Low output failure & systolic dysfunction Positive inotropy ( force of contraction) ventricular ejection, improved tissue perfusion, HR Diuresis, edema & dyspnoea relieved Unable to reverse or retard the pathology No effect on remodelling
41 CURRENT STATUS Slow oral digitalisation Bradycardia Withdraw after compensation restored Low safety margin No alteration of disease progression
42 THERAPEUTIC USES ARRHYTHMIAS AF AFl PSVT ERP of AV node Reduces ventricular rate
43 DIURETICS It is an agent which increases urine volume Natriuretic: It causes an in renal Na+ excretion As it also water excretion they are also known as diuretics
44
45 CLASSIFICATION HIGH EFFICACY/ LOOP Furosemide, Bumetanide, Torsemide MEDIUM EFFICACY Thiazides WEAK OR ADJUNCTS CA inhibitors- Acetazolamide Potassium sparing- Spironolactone Osmotic- Mannitol
46 FUROSEMIDE
47 THIAZIDES
48 DIURETICS High ceiling diuretics- Furosemide ECF, venous return, PRELOAD Cardiac efficiency improved Edema, pulmonary congestion i.v- Rapid symptom relief Intermittent therapy- mild CCF excretion of H+ & K+ Arrhythmias, digoxin toxicity Thiazides- adjuvant in chronic cases resistant to loop diuretics
49 VASODILATORS Acute & chronic CHF Venodilators ( preload) Nitrates Arteriolar dilators ( afterload) CCB, hydralazine, minoxidil Mixed dilators ( pre & afterload) ACE inhibitors- Enalapril, Lisinopril ARBs- Losartan, Telmisartan Prazosin PDE III inhibitors
50 NITRATES ventricular EDP & volume i.v- acute LVF Nitrate tolerance HYDRALAZINE aortic impedance Tachycardia, fluid retention
51 ACE INHIBITORS/ARBS
52
53 ACE INHIBITORS/ARBS preload, afterload RAP, PAP, systemic vascular resistance, BP, HR stroke volume, cardiac output, renal perfusion Retard disease progression & prolongs survival First line therapy REDUCES MORBIDITY & MORTALITY
54 DIURETICS, ACE INHIBITORS Reduce the number of sacks on the wagon
55 BETABLOCKERS Carvedilol, metoprolol, bisoprolol Blocks activation of ANS inhibits renin release Prevents arrhythmias Decreases remodelling, hypertrophy & cell death Adjuvant in Mild to moderate CHF No role in decompensated patients Start from low dose & step up
56 Limit the donkey s speed, thus saving energy
57
58 ALDOSTERONE ANTAGONIST Spironolactone Aldosterone- expands E.C.F, fibrotic changes in myocardium, hypokalemia & hypomagnesemia Moderate to severe CHF Add-on therapy to ACEI & other drugs Retards disease progression & death Low doses mg/d hyperkalemia, gynaecomastia
59 PDE III INHIBITORS AMRINONE, MILRINONE PDE III- degrades Camp in heart & smooth muscles Camp in myocardium- Direct vasodilation Positive inotropy- influx of Ca INODILATOR Severe & refractory CHF short term i.v µg/kg/min No oral maintenance therapy Thrombocytopenia, liver damage, arrhythmias
60 SYMPATHOMIMETICS Dobutamine, Dopamine Βeta & dopaminergic agonists Acute CHF No role in long term therapy
61
62
63 STAGE A MANAGEMENT OF HEART FAILURE Risk factors reduction, treat hypertension, DM, dyslipidemia, ACEIs/ARBs STAGE B- ACEIs/ARBs in all patients, beta blockers in selected patients STAGE C- diuretics, ACEIs, beta blockers Aldosterone antagonist, ARBs, hydralazine, digoxin STAGE D- intervention
64 THE END
Heart Failure (HF) Treatment
Heart Failure (HF) Treatment Heart Failure (HF) Complex, progressive disorder. The heart is unable to pump sufficient blood to meet the needs of the body. Its cardinal symptoms are dyspnea, fatigue, and
More informationDrugs Used in Heart Failure. Assistant Prof. Dr. Najlaa Saadi PhD pharmacology Faculty of Pharmacy University of Philadelphia
Drugs Used in Heart Failure Assistant Prof. Dr. Najlaa Saadi PhD pharmacology Faculty of Pharmacy University of Philadelphia Heart Failure Heart failure (HF), occurs when cardiac output is inadequate to
More informationHeart Failure. Subjective SOB (shortness of breath) Peripheral edema. Orthopnea (2-3 pillows) PND (paroxysmal nocturnal dyspnea)
Pharmacology I. Definitions A. Heart Failure (HF) Heart Failure Ezra Levy, Pharm.D. HF Results when one or both ventricles are unable to pump sufficient blood to meet the body s needs There are 2 types
More informationHeart failure. Failure? blood supply insufficient for body needs. CHF = congestive heart failure. increased blood volume, interstitial fluid
Failure? blood supply insufficient for body needs CHF = congestive heart failure increased blood volume, interstitial fluid Underlying causes/risk factors Ischemic heart disease (CAD) 70% hypertension
More informationHeart Failure. Dr. Alia Shatanawi
Heart Failure Dr. Alia Shatanawi Left systolic dysfunction secondary to coronary artery disease is the most common cause, account to 70% of all cases. Heart Failure Heart is unable to pump sufficient blood
More informationHEART FAILURE PHARMACOLOGY. University of Hawai i Hilo Pre- Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D
HEART FAILURE PHARMACOLOGY University of Hawai i Hilo Pre- Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D 1 LEARNING OBJECTIVES Understand the effects of heart failure in the body
More informationHEART FAILURE. Heart Failure in the US. Heart Failure (HF) 3/2/2014
HEART FAILURE Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center March 2014 Heart Failure in the US Prevalence - ~5 million 650,000 new cases annually 300,000 deaths annually Leading
More informationCardiac Drugs: Chapter 9 Worksheet Cardiac Agents. 1. drugs affect the rate of the heart and can either increase its rate or decrease its rate.
Complete the following. 1. drugs affect the rate of the heart and can either increase its rate or decrease its rate. 2. drugs affect the force of contraction and can be either positive or negative. 3.
More informationAntihypertensive drugs SUMMARY Made by: Lama Shatat
Antihypertensive drugs SUMMARY Made by: Lama Shatat Diuretic Thiazide diuretics The loop diuretics Potassium-sparing Diuretics *Hydrochlorothiazide *Chlorthalidone *Furosemide *Torsemide *Bumetanide Aldosterone
More informationTowards a Greater Understanding of Cardiac Medications Foundational Cardiac Concepts That Must Be Understood:
Towards a Greater Understanding of Cardiac Medications Foundational Cardiac Concepts That Must Be Understood: Cardiac Output (CO) CO=SVxHR (stroke volume x heart rate) Cardiac output: The amount of blood
More informationIntroductory Clinical Pharmacology Chapter 41 Antihypertensive Drugs
Introductory Clinical Pharmacology Chapter 41 Antihypertensive Drugs Blood Pressure Normal = sys
More informationImages have been removed from the PowerPoint slides in this handout due to copyright restrictions.
Heart Failure Heart Failure Introduction and History AHA 2015 Statistics About 6 million Americans 870,000 new cases each year 1 in 9 deaths related to HF Almost 1 million hospitalizations each year (cost
More informationEstimated 5.7 million Americans with HF. 915, 000 new HF cases annually, HF incidence approaches
Heart Failure: Management of a Chronic Disease Jenny Bauerly RN, CHFN, APRN-BC Heart Failure (HF) Definition A complex clinical syndrome that can result from any structural or functional cardiac disorder
More informationCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Normal Cardiac Anatomy
Mosby,, an affiliate of Elsevier Normal Cardiac Anatomy Impaired cardiac pumping Results in vasoconstriction & fluid retention Characterized by ventricular dysfunction, reduced exercise tolerance, diminished
More informationAntihypertensive Agents Part-2. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia
Antihypertensive Agents Part-2 Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Agents that block production or action of angiotensin Angiotensin-converting
More informationM2 TEACHING UNDERSTANDING PHARMACOLOGY
M2 TEACHING UNDERSTANDING PHARMACOLOGY USING CVS SYSTEM AS AN EXAMPLE NIGEL FONG 2 JAN 2014 TODAY S OBJECTIVE Pharmacology often seems like an endless list of mechanisms and side effects to memorize. To
More informationMedical Treatment for acute Decompensated Heart Failure. Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011
Medical Treatment for acute Decompensated Heart Failure Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011 2010 HFSA guidelines for ADHF 2009 focused update of the 2005 American College
More informationHeart Failure Clinician Guide JANUARY 2016
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Heart Failure Clinician Guide JANUARY 2016 Introduction This evidence-based guideline summary is based on the 2016 National Heart Failure Guideline.
More informationDefinition of Congestive Heart Failure
Heart Failure Definition of Congestive Heart Failure A clinical syndrome of signs & symptoms resulting from the heart s inability to supply adequate tissue perfusion. CHF Epidemiology Affects 4.7 million
More informationCongestive Heart Failure (CHF) Edward JN Ishac, Ph.D.
Congestive Heart Failure (CHF) Edward JN Ishac, Ph.D. Smith Building, Room 742 eishac@vcu.edu 828-2127 Department of Pharmacology and Toxicology Medical College of Virginia Campus of Virginia Commonwealth
More informationLeading Causes of Death in the U.S. Congestive Heart Failure (CHF) Edward JN Ishac, Ph.D. Blood flow at rest and exercise
Congestive Heart Failure (CHF) Leading Causes of Death in the U.S Edward JN Ishac, Ph.D. Smith Building, Room 742 eishac@vcu.edu 828-2127 Department of Pharmacology and Toxicology Medical College of Virginia
More informationHeart Failure Clinician Guide JANUARY 2018
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Heart Failure Clinician Guide JANUARY 2018 Introduction This evidence-based guideline summary is based on the 2018 National Heart Failure Guideline.
More informationA Guide to the Etiology, Pathophysiology, Diagnosis, and Treatment of Heart Failure. Part I: Etiology and Pathophysiology of Heart Failure
A Guide to the Etiology, Pathophysiology, Diagnosis, and Treatment of Heart Failure Dr Badri Paudel GMC Part I: Etiology and Pathophysiology of Heart Failure Heart Failure (HF) Definition A complex clinical
More informationHYPERTENSION: Sustained elevation of arterial blood pressure above normal o Systolic 140 mm Hg and/or o Diastolic 90 mm Hg
Lecture 39 Anti-Hypertensives B-Rod BLOOD PRESSURE: Systolic / Diastolic NORMAL: 120/80 Systolic = measure of pressure as heart is beating Diastolic = measure of pressure while heart is at rest between
More informationPre-discussion questions
Amanda Bartlett, PA-C Dustin Bartlett, PA-C Andrea Applegate, PA-C Leslie Yearta Brown, NP CHF Round Table Discussion Objectives ANDREA- Discuss the definition and different categories of CHF DUSTIN- Define
More informationBeta 1 Beta blockers A - Propranolol,
Pharma Lecture 3 Beta blockers that we are most interested in are the ones that target Beta 1 receptors. Beta blockers A - Propranolol, it s a non-selective competitive antagonist of beta 1 and beta 2
More informationHeart Failure CTSHP Fall Seminar
Heart Failure CTSHP Fall Seminar Laurajo Ryan, PharmD, MSc, BCPS, CDE Pharmacist Learning Objectives Outline the pathophysiology of heart failure List triggers for decompensated heart failure Describe
More information1/4/18. Heart Failure Guideline Review and Update. Disclosure. Pharmacist Objectives. Pharmacy Technician Objectives. What is Heart Failure?
Disclosure Heart Failure Guideline Review and Update I have had no financial relationship over the past 12 months with any commercial sponsor with a vested interest in this presentation. Natalie Beiter,
More informationChapter 10. Learning Objectives. Learning Objectives 9/11/2012. Congestive Heart Failure
Chapter 10 Congestive Heart Failure Learning Objectives Explain concept of polypharmacy in treatment of congestive heart failure Explain function of diuretics Learning Objectives Discuss drugs used for
More informationImproving Transition of Care in Congestive Heart Failure. Mark J. Gloth, DO, MBA. Vice President, Chief Medical Officer HCR ManorCare
Improving Transition of Care in Congestive Heart Failure Mark J. Gloth, DO, MBA. Vice President, Chief Medical Officer HCR ManorCare Heart Failure Fastest growing clinical cardiac disease in the United
More informationHEART FAILURE. Heart Failure in the US. Heart Failure (HF) 10/5/2015. Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center
HEART FAILURE Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center Heart Failure in the US Prevalence - ~5 million 650,000 new cases annually 300,000 deaths annually Leading DRG among
More informationAntihypertensives. Antihypertensive Classes. RAAS Inhibitors. Renin-Angiotensin Cascade. Angiotensin Receptors. Approaches to Hypertension Treatment
Approaches to Hypertension Treatment Antihypertensives Inhibit Sympathetic impulses Inhibit contractility Inhibit heart rate Inhibit vasoconstriction Inhibit smooth muscle function Inhibit RAAS Inhibit
More information7/7/ CHD/MI LVH and LV dysfunction Dysrrhythmias Stroke PVD Renal insufficiency and failure Retinopathy. Normal <120 Prehypertension
Prevalence of Hypertension Hypertension: Diagnosis and Management T. Villela, M.D. Program Director University of California, San Francisco-San Francisco General Hospital Family and Community Medicine
More informationHeart Failure. Cardiac Anatomy. Functions of the Heart. Cardiac Cycle/Hemodynamics. Determinants of Cardiac Output. Cardiac Output
Cardiac Anatomy Heart Failure Professor Qing ZHANG Department of Cardiology, West China Hospital www.blaufuss.org Cardiac Cycle/Hemodynamics Functions of the Heart Essential functions of the heart to cover
More informationDiastolic Heart Failure. Edwin Tulloch-Reid MBBS FACC Consultant Cardiologist Heart Institute of the Caribbean December 2012
Diastolic Heart Failure Edwin Tulloch-Reid MBBS FACC Consultant Cardiologist Heart Institute of the Caribbean December 2012 Disclosures Have spoken for Merck, Sharpe and Dohme Sat on a physician advisory
More informationCongestive Heart Failure
Congestive Heart Failure (CHF) Congestive Heart Failure - 2007 Edward JN Ishac. Ph.D. Associate Professor, Dept. Pharmacology & Toxicology Office: Smith 742; Tel: 828 2127 eishac@vcu.edu Heart failure:
More informationHeart Failure. Jay Shavadia
Heart Failure Jay Shavadia Definition Clinical syndrome characterized by: Symptoms: breathlessness at rest or on exercise, fatigue, tiredness or ankle swelling AND Signs: tachycardia, tachypnea, pulmonary
More informationMEDICAL MANAGEMENT OF PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION
MEDICAL MANAGEMENT OF PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION FRANCIS X. CELIS, D.O. OPSO FALL CONFERENCE PORTLAND, OR 16 SEPTEMBER 2017 OVERVIEW What are the ACC/AHA Stages of HF? What
More informationCKD Satellite Symposium
CKD Satellite Symposium Recommended Therapy by Heart Failure Stage AHA/ACC Task Force on Practice Guideline 2001 Natural History of Heart Failure Patients surviving % Mechanism of death Sudden death 40%
More informationHeart Failure Treatments
Heart Failure Treatments Past & Present www.philippelefevre.com Background Background Chronic heart failure Drugs Mechanical Electrical Background Chronic heart failure Drugs Mechanical Electrical Sudden
More informationDiagnosis & Management of Heart Failure. Abena A. Osei-Wusu, M.D. Medical Fiesta
Diagnosis & Management of Heart Failure Abena A. Osei-Wusu, M.D. Medical Fiesta Learning Objectives: 1) Become familiar with pathogenesis of congestive heart failure. 2) Discuss clinical manifestations
More informationDisclosure Statement. Heart Failure: Refreshers and Updates. Objectives. CHF: Chronic Heart Failure. Definitions. Definitions 2/19/2018
Disclosure Statement Heart Failure: Refreshers and Updates Tracy K. Pettinger, PharmD Clinical Associate Professor College of Pharmacy The planners and presenter of this presentation have disclosed no
More informationTopic Page: congestive heart failure
Topic Page: congestive heart failure Definition: congestive heart f ailure from Merriam-Webster's Collegiate(R) Dictionary (1930) : heart failure in which the heart is unable to maintain an adequate circulation
More informationDysrhythmias. Dysrythmias & Anti-Dysrhythmics. EKG Parameters. Dysrhythmias. Components of an ECG Wave. Dysrhythmias
Dysrhythmias Dysrythmias & Anti-Dysrhythmics Rhythm bad in the heart: Whitewater rafting Electrical impulses coordinate heart Reduction in Cardiac Output PEA Asystole Components of an ECG Wave EKG Parameters
More informationHeart Failure Update John Coyle, M.D.
Heart Failure Update 2011 John Coyle, M.D. Causes of Heart Failure Anderson,B.Am Heart J 1993;126:632-40 It It is now well-established that at least one-half of the patients presenting with symptoms and
More informationThe Failing Heart in Primary Care
The Failing Heart in Primary Care Hamid Ikram How fares the Heart Failure Epidemic? 4357 patients, 57% women, mean age 74 years HFSA 2010 Practice Guideline (3.1) Heart Failure Prevention A careful and
More informationCongestive Heart Failure Patient Profile. Patient Identity - Mr. Douglas - 72 year old man - No drugs, smokes, moderate social alcohol consumption
Congestive Heart Failure Patient Profile Patient Identity - Mr. Douglas - 72 year old man - No drugs, smokes, moderate social alcohol consumption Chief Complaint - SOB - When asked: Increasing difficulty
More informationCardiorenal and Renocardiac Syndrome
And Renocardiac Syndrome A Vicious Cycle Cardiorenal and Renocardiac Syndrome Type 1 (acute) Acute HF results in acute kidney injury Type 2 Chronic cardiac dysfunction (eg, chronic HF) causes progressive
More informationCirculation. Blood Pressure and Antihypertensive Medications. Venous Return. Arterial flow. Regulation of Cardiac Output.
Circulation Blood Pressure and Antihypertensive Medications Two systems Pulmonary (low pressure) Systemic (high pressure) Aorta 120 mmhg Large arteries 110 mmhg Arterioles 40 mmhg Arteriolar capillaries
More informationHypertension (JNC-8)
Hypertension (JNC-8) Southern California University of Health Sciences Physician Assistant Program Management and Treatment of Hypertension April 17, 2018, presented by Ezra Levy, Pharm.D.! The 8 th Joint
More informationLow Efficacy Diuretics. Potassium sparing diuretics. Carbonic anhydrase inhibitors. Osmotic diuretics. Miscellaneous
University of Al Qadisiyah College of Pharmacy Dr. Bassim I Mohammad, MBChB, MSc, Ph.D Low Efficacy Diuretics 1. Potassium sparing diuretics 2. Carbonic anhydrase inhibitors 3. Osmotic diuretics 4. Miscellaneous
More informationDrug Therapy of Heart Failure. Munir Gharaibeh, MD, PhD, MHPE Faculty of Medicine, The University of Jordan November, 2014
Drug Therapy of Heart Failure Munir Gharaibeh, MD, PhD, MHPE Faculty of Medicine, The University of Jordan November, 2014 Drug Therapy of Heart Failure Definition of Heart Failure Causes Classifications
More informationSection 3, Lecture 2
59-291 Section 3, Lecture 2 Diuretics: -increase in Na + excretion (naturesis) Thiazide and Related diuretics -decreased PVR due to decreases muscle contraction -an economical and effective treatment -protect
More informationChapter 10 Worksheet Blood Pressure and Antithrombotic Agents
Complete the following. 1. A layer of cells lines each vessel in the vascular system. This layer is a passive barrier that keeps cells and proteins from going into tissues; it also contains substances
More informationHEART FAILURE. Heart Failure in the US. Heart Failure (HF) 2/20/2017. Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center
HEART FAILURE Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center Heart Failure in the US Prevalence - ~5 million 650,000 new cases annually 300,000 deaths annually Leading DRG among
More informationSummary/Key Points Introduction
Summary/Key Points Introduction Scope of Heart Failure (HF) o 6.5 million Americans 20 years of age have HF o 960,000 new cases of HF diagnosed annually o 5-year survival rate for HF is ~50% Classification
More informationDrugs act on Cardiovascular system (Heart Failure)
Drugs act on Cardiovascular system (Heart Failure) Dr Laith M Abbas Al-Huseini M.B.Ch.B, M.Sc., M.Res., Ph.D. Department of Pharmacology and Therapeutics efinition and Pathophysiology Heart failure (HF)
More informationCongestive Heart Failure 2015
Definition Congestive Heart Failure 215 JP Mehegan/ Mercy Cardiology n Cardiac failure; Congestive heart failure; Chronic heart failure (synonyms) n When the heart is unable to pump sufficiently and at
More informationΔακτυλίτιδα και Ινότροπα Φάρμακα στην Καρδιακή Ανεπάρκεια. Ι.Κανονίδης
Δακτυλίτιδα και Ινότροπα Φάρμακα στην Καρδιακή Ανεπάρκεια Ι.Κανονίδης Cardiac Glycosides Chronic Congestive Heart Failure DIGOXIN Na-K ATPase Na + K + Na-Ca Exchange Na + Ca ++ Ca ++ K + Na + Myofilaments
More informationChapter 23. Media Directory. Cardiovascular Disease (CVD) Hypertension: Classified into Three Categories
Chapter 23 Drugs for Hypertension Slide 37 Slide 41 Media Directory Nifedipine Animation Doxazosin Animation Upper Saddle River, New Jersey 07458 All rights reserved. Cardiovascular Disease (CVD) Includes
More informationMedical Management of Acutely Decompensated Heart Failure. William T. Abraham, MD Director, Division of Cardiovascular Medicine
Medical Management of Acutely Decompensated Heart Failure William T. Abraham, MD Director, Division of Cardiovascular Medicine Orlando, Florida October 7-9, 2011 Goals of Acute Heart Failure Therapy Alleviate
More informationContemporary Management of Heart Failure. Keerthy K Narisetty, MD Comprehensive Heart Failure Management Program BHHI Primary Care Symposium
Contemporary Management of Heart Failure Keerthy K Narisetty, MD Comprehensive Heart Failure Management Program BHHI Primary Care Symposium Disclosures I have no relevant relationships with commercial
More informationPathophysiology: Heart Failure
Pathophysiology: Heart Failure Mat Maurer, MD Irving Assistant Professor of Medicine Outline Definitions and Classifications Epidemiology Muscle and Chamber Function Pathophysiology Heart Failure: Definitions
More information1. Antihypertensive agents 2. Vasodilators & treatment of angina 3. Drugs used in heart failure 4. Drugs used in arrhythmias
1. Antihypertensive agents 2. Vasodilators & treatment of angina 3. Drugs used in heart failure 4. Drugs used in arrhythmias Only need to know drugs discussed in class At the end of this section you should
More informationsympatholytics sympatholytics sympatholytics
sympatholytics sympatholytics sympatholytics CNS-ACTING SYMPATHOPLEGICS Sympathetic brain signals Doesn t affect baroreceptor reflex (no orthostatic hypotension) Methyldopa α-methylne crosses BBB (+) α-adrenoreceptors
More informationTreatment of Congestive Heart Failure
Treatment of Congestive Heart Failure Öner Süzer www.onersuzer.com osuzer@istanbul.edu.tr Last update: 13.01.2009 1 2 1 Congestive Heart Failure I Congestive heart failure (CHF) is a major contributor
More informationOutline. Pathophysiology: Heart Failure. Heart Failure. Heart Failure: Definitions. Etiologies. Etiologies
Outline Pathophysiology: Mat Maurer, MD Irving Assistant Professor of Medicine Definitions and Classifications Epidemiology Muscle and Chamber Function Pathophysiology : Definitions An inability of the
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationContents DEFINITION. TYPES EPIDEMIOLOGY PATHOPHYSIOLOGY. CLINICAL PRESENTATION. DIAGNOSIS. TREATMENT. EVALUATION OF THERAPEUTIC OUTCOMES.
Heart Failure Contents DEFINITION. TYPES EPIDEMIOLOGY PATHOPHYSIOLOGY. CLINICAL PRESENTATION. DIAGNOSIS. TREATMENT. EVALUATION OF THERAPEUTIC OUTCOMES. DEFINITION Heart failure (HF) is a progressive clinical
More informationDIAGNOSIS AND MANAGEMENT OF ACUTE HEART FAILURE
DIAGNOSIS AND MANAGEMENT OF ACUTE HEART FAILURE Mefri Yanni, MD Bagian Kardiologi dan Kedokteran Vaskular RS.DR.M.Djamil Padang The 3rd Symcard Padang, Mei 2013 Outline Diagnosis Diagnosis Treatment options
More informationHypertension. Penny Mosley MRPharmS
Hypertension Penny Mosley MRPharmS Outline of presentation Introduction to hypertension Physiological control of arterial blood pressure What determines our bp? What determines the heart rate? What determines
More informationNora Goldschlager, M.D. SFGH Division of Cardiology UCSF
CLASSIFICATION OF HEART FAILURE Nora Goldschlager, M.D. SFGH Division of Cardiology UCSF DISCLOSURES: NONE CLASSIFICATION C OF HEART FAILURE NYHA I IV New paradigm Stage A: Pts at high risk of developing
More informationCONGESTIVE HEART FAILURE
CASE STUDY 3 CONGESTIVE HEART FAILURE For the Patient Case for this case study, see the printed book. DISEASE SUMMARY Definition Congestive heart failure (CHF) is not a specific disease but a common, progressive
More informationHeart Failure. Dr. William Vosik. January, 2012
Heart Failure Dr. William Vosik January, 2012 Questions for clinicians to ask Is this heart failure? What is the underlying cause? What are the associated disease processes? Which evidence-based treatment
More informationDRUG CLASSES BETA-ADRENOCEPTOR ANTAGONISTS (BETA-BLOCKERS)
DRUG CLASSES BETA-ADRENOCEPTOR ANTAGONISTS (BETA-BLOCKERS) Beta-blockers have been widely used in the management of angina, certain tachyarrhythmias and heart failure, as well as in hypertension. Examples
More informationDRUGS USED TO TREAT HYPERTENSION BY ALI ALALAWI
DRUGS USED TO TREAT HYPERTENSION BY ALI ALALAWI 3. Vasodilators Drugs which dilate blood vessels ( decrease peripheral vascular resistance) by acting on smooth muscle cells through non-autonomic mechanisms:
More informationPharmacotherapy of Heart Failure (CHF) Inotropics and Other Agents. Edward JN Ishac, Ph.D.
Pharmacotherapy of Heart Failure (CHF) Inotropics and Other Agents Edward JN Ishac, Ph.D. Smith Building, Room 742 eishac@vcu.edu 828-2127 Department of Pharmacology and Toxicology Medical College of Virginia
More informationHeart Failure Dr ahmed almutairi Assistant professor internal medicin dept
Heart Failure Dr ahmed almutairi Assistant professor internal medicin dept (MBBS)(SBMD) Introduction Epidemiology Pathophysiology diastolic/systolic Risk factors Signs and symptoms Classification of HF
More informationAtrial fibrillation in the ICU
Atrial fibrillation in the ICU Atrial fibrillation Preexisting or incident (new onset) among nearly one in three critically ill patients Formation of arrhythogenic substrate usually fibrosis (CHF, hypertension,
More informationANTI - ARRHYTHMIC DRUGS
ANTI - ARRHYTHMIC DRUGS CARDIAC ACTION POTENTIAL K Out Balance Ca in/k out Na in K Out GENERATION OF ARRHYTHMIAS Four mechanisms of arrhythmia generation; Increased normal automaticity Abnormal automaticity
More informationHeart Failure: Combination Treatment Strategies
Heart Failure: Combination Treatment Strategies M. McDonald MD, FRCP State of the Heart Symposium May 28, 2011 None Disclosures Case 69 F, prior MIs (LV ejection fraction 25%), HTN No demonstrable ischemia
More informationIncidence. 4.8 million in the United States. 400,000 new cases/year. 20 million patients with asymptomatic LV dysfunction
Heart Failure Diagnosis According to the Working Group in Heart Failure, CHF is a syndrome where the diagnosis has the following essential components: A combination of: Symptoms, typically breathlessness
More informationDifficult to Treat Hypertension
Difficult to Treat Hypertension According to Goldilocks JNC 8 Blood Pressure Goals (2014) BP Goal 60 years old and greater*- systolic < 150 and diastolic < 90. (Grade A)** BP Goal 18-59 years old* diastolic
More informationAntialdosterone treatment in heart failure
Update on the Treatment of Chronic Heart Failure 2012 Antialdosterone treatment in heart failure 전남의대윤현주 Chronic Heart Failure Prognosis of Heart failure Cecil, Text book of Internal Medicine, 22 th edition
More informationESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure
Patients t with acute heart failure frequently develop chronic heart failure Patients with chronic heart failure frequently decompensate acutely ESC Guidelines for the Diagnosis and A clinical response
More informationCardiovascular Pharmacotherapy
Cardiovascular Pharmacotherapy Overview Mechanism of cardiovascular drugs Indications and clinical use in cardiology Renin-Angiotensin Inhibitors: Angiotensin-Converting Enzyme Inhibitors, Angiotensin
More informationVasoactive Medications. Matthew J. Korobey Pharm.D., BCCCP Critical Care Clinical Specialist Mercy St. Louis
Vasoactive Medications Matthew J. Korobey Pharm.D., BCCCP Critical Care Clinical Specialist Mercy St. Louis Objectives List components of physiology involved in blood pressure Review terminology related
More informationHeart. Severe. Failure. Congestive heart failure (CHF) is very. What you can do for your patients
Focus on CME at the University of Université Manitoba de Sherbrooke By Anne Fradet, MD, FRCP, CSPQ Severe Heart Failure What you can do for your patients The case of Mr. White Mr. White, 72, comes to your
More informationDuring exercise the heart rate is 190 bpm and the stroke volume is 115 ml/beat. What is the cardiac output?
The Cardiovascular System Part III: Heart Outline of class lecture After studying part I of this chapter you should be able to: 1. Be able to calculate cardiac output (CO) be able to define heart rate
More informationAwareness of the Patients about the Symptoms of Heart Failure and Length of Delay in Seeking Medical Care in Sudan Heart Center (SHC)
Human Journals Research Article October 2016 Vol.:7, Issue:3 All rights are reserved by Ruaa Babikir Mukhtar et al. Awareness of the Patients about the Symptoms of Heart Failure and Length of Delay in
More informationPeripartum Cardiomyopathy. Lavanya Rai Manipal
Peripartum Cardiomyopathy Lavanya Rai Manipal Definition - PPCM - Dilated cardiomyopathy of unknown cause resulting in cardiac failure that occurs in the peripartum period in women without any preexisting
More informationPharmacology. Drugs affecting the Cardiovascular system (Antianginal Drugs)
Lecture 7 (year3) Dr Noor Al-Hasani Pharmacology University of Baghdad College of dentistry Drugs affecting the Cardiovascular system (Antianginal Drugs) Atherosclerotic disease of the coronary arteries,
More informationWRITER TRISTAN WALKER TABLE OF CONTENTS. The Basics of cardiac pharmacology 2007
WRITER TRISTAN WALKER TABLE OF CONTENTS 1. WHAT ARE THE MAJOR CLASSES OF CARDIAC DRUGS?...2 2. HOW DO THEY WORK?...3 3. CONSIDERATIONS FOR THE PEDIATRIC PATIENT...7 4. SUMMARY TABLE...10 REFERENCES...14
More informationIntroduction. Factors affecting blood pressure: 1-COP = HR X SV mainly affect SBP. 2-TPR = diameter of arterioles X viscosity of blood affect DBP
Introduction Hypertension is a persistent elevation of blood pressure above 140 / 90 mmhg for more than three sitting. (0ptimal level
More informationLXIV: DRUGS: 4. RAS BLOCKADE
LXIV: DRUGS: 4. RAS BLOCKADE ACE Inhibitors Components of RAS Actions of Angiotensin i II Indications for ACEIs Contraindications RAS blockade in hypertension RAS blockade in CAD RAS blockade in HF Limitations
More informationCONGESTIVE HEART FAILURE. IAP UG Teaching slides
CONGESTIVE HEART FAILURE 1 DEFINITION OF CCF Congestive Cardiac Failure ( CCF ) is a clinical syndrome of varied etiology in which the heart is unable to pump enough blood to meet the metabolic needs of
More informationStructure and organization of blood vessels
The cardiovascular system Structure of the heart The cardiac cycle Structure and organization of blood vessels What is the cardiovascular system? The heart is a double pump heart arteries arterioles veins
More information7/21/2017. Learning Objectives. Current Cardiovascular Pharmacology. Epinephrine. Cardiotonic Agents. Epinephrine. Epinephrine. Arthur Jones, EdD, RRT
Learning Objectives Current Cardiovascular Pharmacology Arthur Jones, EdD, RRT Explain the actions, effects, indications, adverse effects, & precautions for agents from the following drug categories Cardiotonic
More informationProtocol Identifier Subject Identifier Visit Description. [Y] Yes [N] No. [Y] Yes [N] N. If Yes, admission date and time: Day Month Year
PAST MEDICAL HISTORY Has the subject had a prior episode of heart failure? o Does the subject have a prior history of exposure to cardiotoxins, such as anthracyclines? URGENT HEART FAILURE VISIT Did heart
More informationThe NEW Heart Failure Guidelines
The NEW Heart Failure Guidelines Daily Practice HF scenario of the Case Presentations HF as a complex and heterogeneous syndrome Several proposed pathophysiological mechanisms involving the heart and the
More information