Sapna Gupta, Associate Professor
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CH 251, Respiratory Drugs, Skeletal Muscle Relaxants, Antihypertensive Drugs, Angina Pectoris, Cardiac Arrhythmias, Congestive Heart Failure, Coagulation Disorders and Hyperlipidia, Endocrine Pharmacology, Male and Female Hormones, Thyroid and Parathyroid, Diabetes

Final Exam Objectives

CONGESTIVE HEART FAILURE

Heart is unable to pump sufficient quantity of blood and fluid accumulates in the peripheral tissue.

There are four cyclic steps:

1) Decreased cardiac output (due to anything: high BP, diseases) -------->

2) nerohormonal compensation (sympathetic system causes hormones to compensate  eg antidiuretic hormones and aldosterone) ---- >

3) increased cardiac workload (general increase in sodium and water retention)----- >

4) changes in mycardial cell function (cell damage)----- > this leads to the first step.

Left heart failure: pulmonary edema

Right heart failure: peripheral edema; swollen ankles and organs

Treatment

Mechanism

Adverse effects

Digitalis glycoside

Increases intracellular Ca2+ thus increasing cardiac contraction

Nausea, diarrhea, CNS disturbance, 20-25% patients get toxicity (keep low dose)

Diuretics

Increases excretion of water and sodium thus reducing vascular fluid the heart needs to pump.

Electrolyte imbalance, fluid loss, pH imbalance

Angiotensin converting enzyme inhibitors (ACE inhibitors)

Suppresses activity of aldosterone (which is responsible for sodium retention)

Very rare

Rehabilitation Concerns:

Look for

  1.  increase in rales, dyspnea, cough,

  2. digitalis toxicity: dizziness, confusion, nausea, arrhythmias

  3. increased fatigue and weakness

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