Drugs are bad... mkay
Most (if not all) drugs that act on the RAAS system have this electrolyte side effect.
What is hyperkalemia?
These 2 hormones oppose the RAAS system. (What are they and what do they do?)
RAAS system increases salt and water retention. ANP (from the atria) and BNP (from the ventricles) work to reduce blood pressure by causing salt and water excretion and peripheral vasodilation.
This is the more common type of dilated cardiomyopathy (primary or secondary).
What is primary?
These are the forces that cause edema to occur.
Hydrostatic pressure increases which leads to fluid leaving the capillaries and entering the interstitial space.
This stage of heart failure sees an increase in symptoms with a regular level of physical activity.
What is stage 2 heart failure?
What is the mechanism of action of aldosterone antagonists (spironolactone)?
They competitive bind to aldosterone receptors in the late distal convoluted tubule and collecting duct.
The baroreceptors in this spot respond to both increases and decreases in blood pressure.
Name 2 things included in the initial diagnostic workup.
Labs (BMP, CBC, LFTs, TSH, HIV), Chest X-ray (potential cardiomegaly and pulmonary edema), ECG (can see a variety of arrhythmias).
A common term in basketball for bouncing the ball between someone's legs, this can also be a symptom of hepatic venous congestion.
What is nutmeg liver?
This stage of heart failure is represented by symptoms of heart failure at rest.
What is stage 4 heart failure?
This drug class should be avoided in patients with asthma or COPD.
What are beta blockers?
The SNS and RAAS stimulate this adrenergic receptor to regulate blood pressure.
What are alpha 1 receptors?
Name the test that is used to confirm dilated cardiomyopathy and characteristic findings of that test.
Echocardiogram is used. Ventricular dilation w/ normal ventricular wall thickness; decreased LVEF.
Why does Rodger have swelling in his extremities with his congestive heart failure?
The right heart is not pumping enough blood, so it is backing up into the venous system and causing peripheral edema and increased jugular venous pressure.
This stage of heart failure sees no limitation in physical activity.
What is stage 1?
Name 2 classes of drugs that you would not prescribe a patient with renal artery stenosis.
Angiotensin receptor blockers (ARBs) and Angiotensin converting enzyme inhibitors (ACE inhibitors).
In heart failure, what specific catecholamine is increased by the SNS.
What is norepinephrine?
Name 3 different causes of secondary dilated cardiomyopathy.
Frederick never smoked, but he is coughing up a storm because of his congestive heart failure. Why is this and explain the mechanism behind it.
Blood cannot move forward, so it is becoming "stuck" in the lungs. This increases the hydrostatic pressure of the pulmonary capillaries which leads to fluid leaving the capillaries and entering the interstitial spaces.
Increased left ventricular preload.
This stage of heart failure sees increased symptoms with any level of activity, but comfort at rest.
What is stage 3 heart failure?
This medication class has a side effect that may lead to many electrolyte imbalances, ringing in the ears, and dehydration.
What are loop diuretics? (furosemide, torsemide, bumetanide)
Sometimes in heart failure, this enzyme is increased that normally degrades ANP and BNP.
What is neprilysin?
Name one gene associated with familial dilated cardiomyopathy.
TTN gene- encodes intrasarcomeric protein titin.
MYH7 gene- encodes beta-myosin heavy chain.
Describe why Billy Bob's congestive heart failure is leading to cold hands and feet.
He has poor cardiac output, so his extremities are under-perfused. Blood is going to be conserved in areas where it is needed more (vital organs).
Name the 4 different classes of heart failure and what they represent.
Class A- at risk for heart failure.
Class B- pre-heart failure.
Class C- symptomatic heart failure.
Class D- advanced heart failure.