Anti-hypertensive drugs and variables affected, hypotension, cardiac disorders, heart (pump) failure, systolic heart failure, left/right ventricular failure, cardiogenic shock, electrical disturbances, abnormal sinus rhythms

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Colorado State University
Biomedical Science
BMS 460
D.Rao Veeramachaneni

6 November Anti-hypertensive Drugs and Variables Affected Reduce stroke volume Thiazide diuretics Loop diuretics Potassium-sparing diuretics Aldosterone receptor blockers Angiotensin (ACE) inhibitors Angiotensin II receptor blockers Venodilators Reduce systemic vascular resistance Combination β- and α1- blockers Angiotensin (ACE) inhibitors Angiotensin II receptor blockers Calcium channel blockers α1-blockers Central α2agonists Direct-acting vasodilators (arterial) Decrease heart rate β-blockers Combination β- and α -1lockers Hypotension Hypovolemia/shock Diarrhea or hemorrhage Anaphylactic shock Orthostatic (postural) hypotension Drop in blood pressure upon standing → syncope Dehydration, hypovolemia, cardiac dysrhythmias, blood loss, diuretics, antihypertensives and pain medication Autonomic nervous system dysfunction: poor vasoconstriction or limited heart rate increase. Diabetic neuropathy limits vasoconstriction as does Parkinson Disease (60%) Six principal mechanisms cause cardiac dysfunction which can operate alone or in combinations Pump failure: Ejection fraction is often lower than normal as the cardiac muscle contracts with poor inotropy and consequently cannot empty properly. In some cases the diastolic function is also poor due to poor relaxation of the ventricular walls. Obstruction of flow: Atherosclerotic lesions or stenotic valves can obstruct flow and cause increased workload on the heart Regurgitant flow: A portion of the outflow blood flows back into the chamber adding a volume workload to respective chambers (e.g., backwards flow to left ventricle in aortic regurgitation and backwards flow to left ventricle and left atrium in mitral valve regurgitation) Shunted flow: Blood can be diverted from one part of the heart to another through defects that may be congenital (left ventricle to right ventricle through ventricular septal defect) or acquired (myocardial infarction) Disorders of cardiac conduction: Arrhythmias due to improperly coordinated generation or propagation of electrical signals along the conduction system lead to ineffective and uncoordinated contractions (atrial fibrillation or ventricular fibrillation) of the muscular walls of the chambers of the heart Rupture of the heart or a major vessel: A gunshot wound to the heart or aorta can result in massive catastrophic bleeding Major Categories of Cardiac Disorders Coronary heart disease Angina pectoris, acute coronary syndrome, sudden cardiac death and chronic ischemic cardiomyopathy Endocardial and valvular diseases Mitral: mitral stenosis, mitral regurgitation, mitral valve prolapse Aortic: aortic stenosis, aortic regurgitation Endocardial: rheumatic heart disease, infectious endocarditis Myocardial diseases Myocarditis, cardiomyopathy (dilated, hypertrophic, restrictive) Pericardial diseases Pericardial effusion (cardiac tamponade) Pericarditis (acute and chronic) Congenital heart diseases Acyanotic congenital defects: ASD, VSD, PDA, coarctation of aorta, pulmonary stenosis, aortic stenosis Cyanotic congenital defects: tetralogy of Fallot, transposition of the great vessels, truncus arteriosus, tricuspid atresia Heart failure and dysrhythmias (arrhythmias) are common sequelae of cardiac diseases Heart Failure (Pump Failure) Heart failure: common progressive condition with a poor outcome (also called congestive heart failure) Cardiac output cannot keep up with metabolic needs of body tissues or if it can, it does so at an elevated preload Common causes include hypertension, valvular disease, ischemic heart disease leading to myocardial infarction Several physiologic mechanisms come into play with heart failure to maintain arterial pressure and perfusion to vital organs (temporarily) The Frank-Starling mechanism – increased filling volume of chambers dilate chambers and improve the functional cross-bridging and therefore stroke volume Myocardial adaptations – including hypertrophy with or without chamber dilation; known as remodeling
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