[PCOL2-MID-01-PT1] DRUGS FOR HEART FAILURE

THIS SET OF FLASH CARDS IS ABOUT CARDIOVASCULAR DRUGS.

• Cardiac

• Smooth

• Skeletal

Our muscles can be?

Cardiac Muscle

What type of muscle is our heart?

Adjacent cell

Action potential enters from?

Ryanodine Receptor-Channel (RyR)

Once the voltage-gated Ca²⁺ channels open, the Ca²⁺ enters cell inducing the release of Ca²⁺ through what channel?

Sarcoplasmic Reticulum

The ryanodine receptor-channels (RyR) is present in?; this is the one responsible in saving/storing the calcium.

Calmodulin

Recall: In the blood vessel the calcium enters and will bind with ______, calling it now a complex.

Calcium Calmodulin Complex

Recall: This is what activates the myosin light chain kinase (enzyme); phosphorylating the muscle fiber, myosin light chain.

Contraction

Recall: What is the effect of Myosin Light Chain with Phosphate + Actin in the blood vessel?

Cardiac Myocytes

What do you call the cells in our heart?

• Troponin

• Tropomyosin

• Actin

What are the three (3) proteins present in the cardiac myocytes?

Hint: TTA

1. Tropomyosin

2. Troponin

1. This is a cap (takip) of the actin.

2. Ano yung nakadikit sa tropomyosin?

Info

There is no calmodulin in the heart, instead there is troponin. The ca²⁺ will bind to the troponin. Since troponin was activated by the ca²⁺, hihilain niya si tropomyosin because of conformational change, which is the cap of the actin exposing it, allowing it to bind the myosin with the actin causing contraction.

What happens when calcium exceeds its limit?

• Via Sarco/Endoplasmic Reticulum Calcium ATPase (SERCA) Transporter

• Via Calcium Extrusion by Sodium

What are the two (2) mechanisms of relaxation?

SERCA Transporter

This transporter brings back the Ca²⁺ inside the sarcoplasmic reticulum (SR).

Info

Kapag naibalik si Ca²⁺ sa Sarcoplasmic Reticulum (SR) gamit ang SERCA Transporter, the level of Ca²⁺ in the cytoplasm is low.

Calcium Extrusion by Sodium

This mechanism is is the process in which sodium enters the cell while calcium is transported out, thereby lowering the intracellular calcium concentration.

Na⁺K⁺ ATPase Pump

This is responsible for the inward of 2K⁺ in exchange of efflux of 3Na⁺.

Info

In Na⁺K⁺ Exchanger, 1 Na⁺ in, 1 K⁺ out.

Info

When the Na⁺K⁺ ATPase Pump is activated, the Na⁺Ca⁺ Exchanger gets activated too.

Na⁺Ca⁺ Exchanger

Saan galing yung 3Na⁺ out sa Na⁺K⁺ ATPase Pump?

Ejection Fraction

This is the percentage of blood pumped out of the left ventricle with each heartbeat. It is a measure of how well the heart is pumping.

Ejection Fraction = Stroke Volume / End Diastolic Volume

What is the formula for the calculation of ejection fraction?

Stroke Volume

This is the amount/volume of blood per beat.

End Diastolic Volume

This is the preload, referring to the volume of blood in the ventricle at the end of diastole before ventricular contraction.

Info

Ejection Fraction is the ratio of how much was ejected with respect to the amount that was received/entered the heart.

1. Normal

2. 50-65%

Ejection Fraction: Interpretation

What is the (1) interpretation of the heart pumping normally and can deliver an adequate supply of blood to the body and brain and its ejection fraction is between (2)_____%?

1. Below Normal

2. 36-49%

Ejection Fraction: Interpretation

What is the (1) interpretation that could indicate that the heart is not pumping well enough to meet the body’s needs and its ejection fraction is between (2)_____%?

1. Low

2. 35%

Ejection Fraction: Interpretation

What is the (1) interpretation that indicates a weakened heart muscle and poorly pumping heart and its ejection fraction is between (2)_____%?

Sudden Cardiac Arrest (SCA)

Low EF number increases the risk of?

Heart Failure

This is the progressive inability of the heart to supply adequate blood to flow to vital organs.

The heart cannot meet the metabolic requirements of the peripheral systems.

Impairment of the heart’s ability to fill or empty the left ventricle properly.

Congestive Heart Failure (CHF)

Heart Failure is also known as?

Edema/Edematous

Kapag congestive ang heart may presence of pagmamanas or?

• Dyspnea

• Edema

• Fatigue

What are the three (3) Cardinal Symptoms of Heart Failure?

Hint: DEF

Dyspnea

Cardinal Symptoms:

This refers to the difficulty of breathing.

Orthopnea

Dyspnea:

This refers to the difficulty of breathing when lying flat.

Paroxysmal-nocturnal

Dyspnea:

This refers to the sudden difficulty of breathing that awakens the patient while asleep.

Edema

Cardinal Symptoms:

This refers to the high amount of blood in the heart.

• Peripheral

• Pulmonary

What are the two (2) types of Edema?

Peripheral Edema

This type of edema has something to do with a problem in the right ventricle.

Right Sided Heart Failure

Peripheral Edema is also known as?

Kapag madami yung blood in this side, there is a possibility na bumalik yung blood sa vena cava (supplier of the deoxygenated blood).

Pulmonary Edema

This type of edema has something to do with a problem in the left ventricle.

Left Sided Heart Failure

Pulmonary Edema is also known as?

Pulmonary Vein

This vein is the one that supplies blood papunta sa left side ng puso.

Fatigue

Cardinal Symptom:

This occurs because the failing heart cannot pump enough blood to deliver adequate oxygen to the muscles, leading to early exhaustion.

Cardiomegaly

Cardinal Symptom:

This is the enlargement of the heart due to increased workload or underlying heart disease, often as a compensatory response to maintain cardiac output.

Info

Cardinal Symptom: In heart failure, there is a presence of 3rd heart sound (S3)

Normal: S1 (lub), S2 (dub)