Insuficiencia Cardiaca

Get Started. It's Free
or sign up with your email address
Insuficiencia Cardiaca by Mind Map: Insuficiencia Cardiaca

1. Heart Failure

2. Although these compensatory mechanisms initially maintain cardiac function, they are responsible for the symptoms of CHF and contribute to disease progression.

2.1. -Decrease contractility -Increase heart rate -Increase preload -Increase afterload -Increase workload of heart

3. Síntomas -Taquicardia -disminucion de tolerancia en ejercicio -Cardiomegalia -Disnea -Fatiga -Retention de fluidos -Edema Pulmonar -Edema periferico

4. Agents that prolong life in patients with chronic heart failure;

4.1. -Angiotensin-converting enzyme (ACE) inhibitors, -angiotensin receptor blockers, -beta blockers, -aldosterone receptor antagonists, -combined hydralazine-nitrate therapy

5. Second-line therapy -Diuretics -Positive Inotropic drugs

6. First-line therapy -ACE inhibitors -Vasodilators -β blocker

7. introducción

7.1. resulta en ventriculo incapaz de llenado completo y disminuye su Fraccion de eyeccion (Aumenta la demanda del trabajo cardiaco.

7.2. Debido a 2 Tipos

7.2.1. Mecanismos Compensatorios: 1)Taquicardia y aumento de contractibilidad atravez del sistema nervioso central. 2)El mecanismo de Frank-Starling 3)Vasoconstriccion 4)Hipertrofia ventricular y deformacion.

7.2.2. 1)Disfunción Sistólica -Reducción en masa muscular, cardiomiopatías, y Hipertrofia Ventricular -Resulta en la incapacidad del ventrículo para bombear sangre efectivamente.

7.2.3. 2) Disfuncion Diastolica

7.2.4. Aumento de rigidez ventricular, Hipertrofia ventricular , Miocardiopatías infiltrativas, isquemia miocardica y IAM, Estenosis Mitral o Tricuspide y pericarditis

8. Síntomas

9. Fisiológia compensatoria

10. MANAGEMENT

10.1. -Management of heart failure Treatment focuses on improving the symptoms and preventing the progression of the disease. -Treatments include lifestyle and pharmacological modalities.

10.2. Acute decompensated heart failure

10.2.1. -In acute decompensated heart failure, the immediate goal is to re-establish adequate perfusion and oxygen delivery to end organs.

10.2.2. -This entails ensuring that airway, breathing, and circulation are adequate.

10.3. Chronic management

10.3.1. -The goals of treatment for people with chronic heart failure are the prolongation of life, the prevention of acute decompensation and the reduction of symptoms, allowing for greater activity.

10.3.1.1. Positive inotropic drugs, very helpful in acute failure. Diastolic dysfunction does not usually respond optimally to positive inotropic drugs

10.3.2. -Treatment strategies provide significant improvement in the relief of symptoms, exercise tolerance, and a decrease in the likelihood of hospitalization or death.

11. 2 DISTINCT GOALS OF DRUG THERAPY

11.1. (a) Relief of congestive/low output symptoms: *ACE inhibitors *Vasodilators -nitrate,, nitroprusside,hydralazine *β blocker—Nebivolol, Carvedilol, Metoprolol, bisoprolol *Diuretics—Furosemide (Loop diuretic), thiazides * Positive Inotropic drugs—Digoxin, dobutamine

11.2. (b) Arrest/reversal of disease progression and prolongation of survival: *ACE inhibitors, *β blockers *Aldosterone antagonist- Spironolactone, eplerenone

12. SEQUENCE-LINE OF THERAPY

13. Cardiac Glycosides

13.1. This drug increase the contractality of the heart.

13.2. Mechanism of action

13.2.1. Inhibit Na + / K + ATPase enzyme

13.3. PHARMACOLOGICAL ACTIONS:

13.3.1. 1- Increase the force of myocardial contraction (+ve inotropic) leading to decrease in: heart size, venous pressure and edema 2- Slow heart rate ( -ve chronotropic ) by vagal stimulation

13.4. Therapeutic uses

13.4.1. - Congestive heart failure -Atrial arrhythmias: - Atrial flutter - Atrial fibrillation - Supraventricular tachycardia

13.5. Cardiac adverse effects

13.5.1. - digitalis-induced arrhythmias can cause any type of arrhythmia especially: - extrasystoles - coupled beats (Bigeminal rhythms ) - ventricular tachycardia or fibrillation - A.V.block, - cardiac arrest.

13.6. Calcium:

13.6.1. synergises with digitalis → precipitates toxicity.

13.7. Extra cardiac adverse effects

13.7.1. -GIT : common ( the earliest signs of toxicity ): Anorexia,nausea, vomiting, diarrhea CNS: Headache, visual disturbances, drowsiness

13.8. Factors that increase digitalis toxicity: - Small Lean body mass - Renal diseases - Hypothyroidism - Hypokalemia - Hypomagnesemia - Hypercalemia

14. Tratamiento Farmacologico

14.1. Diureticos

14.1.1. causa hipopotasemia que incrementa el riesgo de arritmias digitalis; potassium supplements should be given prophylactically.

14.2. Verapamil, diltiazem, captopril, propafenone and amiodarone

14.2.1. increase plasma concentration of digoxin → plasma concentration of digoxin is doubled → toxicity can occur.

14.3. Adrenérgicos

14.3.1. Pueden inducir arritmias (ambas incrementan la automaticidad ectópica)

14.3.2. Drogas atropónicas aumentan la absorción

14.4. Propranolol, verapamil, diltiazem and disopyramide:

14.4.1. may additively depress A-V conduction and oppose positive inotropic action.

14.5. Digoxin

14.5.1. Q

14.5.1.1. Succinylcholine:

14.5.2. can induce arrhythmias in digitalized patients.