文档介绍：Acute Heart Failure/ Cardiogenic Shock
April 16, 2004
Darren M. Triller, PharmD
The plan
Stick close to the text
Review pharmacology and pathophysiology only to enhance understanding of the drug therapy
Know the few drugs well
Expectations for pharmacists in general hospital or home care practice
Test questions will target these goals
Why is this important?
mon diagnosis
Hospitalizations mon
Associated costs are astronomical
Pharmacists will routinely be involved in preparing and dispensing to U
Use of the drugs is frequently in urgent/emergent situations
Acute HF/Cardiogenic shock
Death
Shock
I II Heart Failure III IV
HTN
Drugs
MI
Valve Dz
MI
Relationships/Key Terms
Cardiac output= HR x Stroke volume
MAP= CO x SVR
Preload
Contractility
Afterload
Frank-Starling relationship
The Big Picture in Failure
Preload
Contractility
Need volume to
increase stretch,
Frank Starling
Need contractility and rate to maintain output
Need constriction to maintain pressure
Afterload
Veins
Heart
Arteries
Autoregulation
The ability to maintain blood flow over wide range of perfusion pressures
Cerebral and coronary arteries
Ability declines at MAP <60mmHg
Mediated by
vasoconstrictors: epi, NE, AngII, TxA2, vasopressin
vasodilators: PGI2, NO, adenosine, natriuretic peptides
Normal reflex mechanisms
Increase preload: Na/H20 retention, RAAS
Increased contractility: adrenergic outflow (NE)
Increased afterload: norepi, AngII, endothelin, vasopressin
It is important to relax!
Remember that coronary arteries fill during diastole
Remember that filling during diastole contributes to stroke volume (Starling)
Remember that increasing heart rate decreases ventricular and coronary filling, upsets calcium processing by SR, O2 demand increase
Chronic HF patients have typically maxed out preload, and do not have the reserve that you do
Contractility
Increased contractility will provide increased stroke volume/CO for a given level of preload and afterload
Chronic HF pat