[PCOL2-MID-01-PT2] DRUGS FOR HEART FAILURE

THIS SET OF FLASH CARDS IS ABOUT CARDIOVASCULAR DRUGS.

• Diastolic

• Systolic

What are the two (2) Types of Heart Failure?

Hint: D&S Heart Failure

Diastolic/Filling Problem

This type of heart failure occurs when the heart contracts normally, but the ventricles do not relax properly or are stiff and less blood enters the heart during normal filling.

x filling; ✓ contraction

Thick, stiff heart muscle

Systolic/Pumping Problem

This type of heart failure is when the left ventricle heart muscle doesn’t contract with enough force.

x contract; ✓ filling

Thin, weak heart muscle

Heart Failure with Preserved Ejection Fraction

Diastolic Heart Failure is also referred to as?

Ventricular Relaxation

Systolic Heart Failure has something to do with?

Heart Failure with reduced Ejection Fraction

Systolic Heart Failure is also referred to as?

Info

Diastolic Failure:

• Hypertrophy

• Stiffening

• Loss of adequate relaxation necessary in reducing filling and cardiac output

• Normal ejection fraction

• Significantly reduced stroke volume

Info

Systolic Failure:

• Reduced mechanical pumping (contractility)

• Reduced ejection fraction (<45%)

• Hypertension

• Aging

Diastolic Failure:

How does the heart develop stiffness or thickening?

Hypertrophy

This means increased size of cells.

Myocardial Injury

When we say heart failure, we expect that there is a?

Hint: Injury

• Renin-Angiotensin-Aldosterone System (RAAS)

• Baroreceptor

When the body sensed the low level of cardiac output, it will activate these two (2):

Activation of Neurohumoral System, increasing the sympathetic activity.

Info

Angiotensin II has an effect to the Angiotensin II Type 1 Receptor (AT1R), resulting to vasoconstriction (AngII) or facilitate the release of aldosterone.

Na & H₂O Retention

When there is a release of aldosterone, what is the effect?

Info

Compensatory Mechanisms During Heart Failure:

Considered as a vicious cycle.

• Renin-angiotensin-aldosterone system (Angiotensin II)

• Endothelin release

• Sympathetic stimulation (NE, EPI)

What are the three (3) destructive compensatory mechanisms (heart failure)?

Endothelin release

This compensatory mechanism is a potent vasoconstrictor.

Natriuretic Peptides (Brain Natriuretic Peptide)

This is the only protective compensatory mechanism (heart failure); produced by the ventricles.

Remodeling

Other Compensatory Mechanism:

Dilation and other structural changes that occur in the stressed myocardium.

Ex. Hypertrophy, Dilation of Chambers, Changing of Shape of the Ventricles, Fibrosis, etc.

Hypertrophy

This is the enlargement of myocardial cells due to death of some cardiac muscles caused by ischemia (MI) and release of caspases.

New York Heart Association

NYHA stands for?

Class I

Identify the NYHA Class:

No limitation of physical activity. Ordinary physical activity does not cause undue breathlessness, fatigue, or palpitations.

Class II

Identify the NYHA Class:

Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in undue breathlessness, fatigue, or palpitations.

Class III

Identify the NYHA Class:

Marked limitation of physical activity. Comfortable at rest, but less than ordinary physical activity results in undue breathlessness, fatigue, or palpitations.

Class IV

Identify the NYHA Class:

Unable to carry on any physical activity without discomfort. Symptoms at rest can be present. If any physical activity is undertaken, discomfort is increased.

• American College of Cardiology

• American Heart Association

ACC/AHA stands for?

Stage A

Identify the ACC/AHA Class:

Patients at high risk for heart failure but without structural heart disease or symptoms of heart failure.

Ex. Hypertension, diabetes mellitus, obesity, CAD (post-MI or revascularization), peripheral vascular disease, CVA, family history, exposure to cardiac toxins

No heart failure but high risk

Stage B (Pre-HF)

Identify the ACC/AHA Class:

Patients with structural heart disease but without signs and symptoms of heart failure.

Ex. Prior MI, left ventricular hypertrophy or reduced LVEF, asymptomatic valvular disease

Stage C (Symptomatic)

Identify the ACC/AHA Class:

Patients with structural heart disease with prior or current symptoms of heart failure.

Ex. Known structural heart disease and dyspnea, fatigue, reduced exercise tolerance

Class I-IV

What is the NYHA Class of Stage C (ACA/AHA)?

Stage D (Advanced/Refractory HF)

Identify the ACC/AHA Class:

Patients with refractory heart failure requiring specialized interventions.

Ex. Marked symptoms at rest despite maximal medical therapy, with recurrent hospitalizations

Class III-IV

What is the NYHA Class of Stage D (ACA/AHA)?

Info

Heart Failure: The heart fails to meet the demands of the body.

Components (Pathophysiology):

• Reduced contractility (weak heart)

• High workload (stressed heart)

Info

Pharmacologic Goals in the Treatment of Heart Failure

• Increase the force of myocardial contraction (Inotropic drugs)

• Decrease workload of the heart (Unloader drugs)

Digoxin

Pharmacologic Goals in the Treatment of Heart Failure:

Positive Inotropes — Cardiac Glycosides?

Dobutamine

Pharmacologic Goals in the Treatment of Heart Failure:

Positive Inotropes — Beta-receptor stimulants?

• Inamrinone (formerly called Amrinone)

• Milrinone

Pharmacologic Goals in the Treatment of Heart Failure:

Positive Inotropes — Bipyridines (PDE₃-inhibitor)

• Diuretics

• ACE inhibitors, ARBs and related agents

• Vasodilators

• Beta blockers

Pharmacologic Goals in the Treatment of Heart Failure:

Without Inotropic Effects (Unloader Drugs)

Hint: DAV-B

They are the first-line therapies for chronic heart failure.

Info

Unloader drugs decreases the pre-load and after load.

Istaroxime

Other Positive Inotropic Drugs:

• Investigational steroid derivative

• Inhibits Na⁺K⁺ ATPase (responsible for Ca²⁺ extrusion) and facilitates sequestration of Ca²⁺ by the Sarcoplasmic Reticulum

Levosimendan

Other Positive Inotropic Drugs:

Sensitizes the troponin system to calcium and inhibit phosphodiesterase; an example of calcium sensitizer.

Phosphodiesterase

Which enzyme does levosimendan inhibit?