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    Short-Term and Long-Term Responses To Impaired Cardiac Performance

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    Ck Kma
    Short-term responses to impaired cardiac performance such as salt and water retention, vasoconstriction, and sympathetic stimulation aim to maintain perfusion of vital organs but can have deleterious long-term effects including pulmonary congestion, increased cardiac energy expenditure, and deterioration of cardiac cells leading to cardiomyopathy of overload. Long-term effects are mainly deleterious and include exacerbated pump dysfunction, skeletal muscle catabolism, and impaired relaxation, while hypertrophy and increased collagen may initially unload fibers but ultimately impair function.

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    Short-Term and Long-Term Responses To Impaired Cardiac Performance

    Uploaded by

    Ck Kma
    34 views10 pages
    Short-term responses to impaired cardiac performance such as salt and water retention, vasoconstriction, and sympathetic stimulation aim to maintain perfusion of vital organs but can have deleterious long-term effects including pulmonary congestion, increased cardiac energy expenditure, and deterioration of cardiac cells leading to cardiomyopathy of overload. Long-term effects are mainly deleterious and include exacerbated pump dysfunction, skeletal muscle catabolism, and impaired relaxation, while hypertrophy and increased collagen may initially unload fibers but ultimately impair function.

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    Short-term responses to impaired cardiac performance such as salt and water retention, vasoconstriction, and sympathetic stimulation aim to maintain perfusion of vital organs but can have deleterious long-term effects including pulmonary congestion, increased cardiac energy expenditure, and deterioration of cardiac cells leading to cardiomyopathy of overload. Long-term effects are mainly deleterious and include exacerbated pump dysfunction, skeletal muscle catabolism, and impaired relaxation, while hypertrophy and increased collagen may initially unload fibers but ultimately impair function.

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    34 views10 pages

    Short-Term and Long-Term Responses To Impaired Cardiac Performance

    Uploaded by

    Ck Kma
    Short-term responses to impaired cardiac performance such as salt and water retention, vasoconstriction, and sympathetic stimulation aim to maintain perfusion of vital organs but can have deleterious long-term effects including pulmonary congestion, increased cardiac energy expenditure, and deterioration of cardiac cells leading to cardiomyopathy of overload. Long-term effects are mainly deleterious and include exacerbated pump dysfunction, skeletal muscle catabolism, and impaired relaxation, while hypertrophy and increased collagen may initially unload fibers but ultimately impair function.

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    of 10

    Short-Term and Long-Term Responses

    To Impaired Cardiac Performance


    Response

    Salt and
    retention

    Short-term Effects
    (mainly adaptive;
    hemorrhage, acute
    heart failure)
    water Augments preload

    Vasoconstriction

    Sympathetic
    stimulation
    Cytokine activation

    Maintains pressure
    for perfusion of
    vital organs (brain,
    heart)
    Increases heart rate
    and ejection
    Vasodilatation

    Hypertrophy

    Unloads individual
    muscle fibers

    Increased collagen

    May
    dilatation

    reduce

    Long-term Effects
    (mainly
    deleterious;
    hemorrhage,
    chronic
    heart
    failure)
    Pulmonary
    congestion,
    anasarca
    Exacerbates pump
    dysfunction,
    increases
    cardiac
    energy expenditure
    Increases
    energy
    expenditure
    Skeletal
    muscle
    catabolism,
    deterioration
    of
    endothelial
    function, impaired
    contraction,
    left
    venticle remodeling
    Deterioration and
    death of cardiac
    cells:
    cardiomyopathy of
    overload
    Impairs relaxation

    Etiologic Classification of Cardiomyopathies


    Primary Myocardial Involvement
    Idiopathic
    Familial
    Eosinophilic endomyocardial disease
    Endomyocardial fibrosis
    Secondary Myocardial Involvement
    Infective
    Connective tissue disorders
    Viral myocarditis
    Systemic
    lupus
    erythematosus
    Bacterial myocarditis
    Polyarteritis nodosa
    Fungal myocarditis
    Rheumatoid arthritis
    Protozoal myocarditis
    Progressive
    systemic
    Metazoal myocarditis
    sclerosis
    Spirochetal
    Dermatomyositis
    Rickettsial
    Infiltrations and granulomas
    Metabolic
    Amyloidosis
    Familian storage disease
    Sarcoidosis
    Glycogen storage disease
    Malignancy
    Hemochromatosis
    Neuromuscular
    Mucopolysaccharidoses
    ,
    Muscular dystrophy
    Fabry s disease
    Deficiency
    Myotonic dystrophy
    ,
    Friedreich s ataxia
    Electrolytes
    Sensitivity and toxic reactions
    Nutritional
    Alcohol
    Radiation
    Drugs
    Peripartum heart disease

    Clinical Classification of Cardiomyopathies


    1.

    2.

    3.

    Dilated: Left and/or right ventricular


    enlargement, impaired systolic function,
    congestive heart failure, arrhythmias, emboli
    Restrictive: Endomyocardial scarring or
    myocardial infiltration resulting in restriction
    to left and/or right ventricular filling
    Hypertrophic:
    Disproportionate
    left
    ventricular hypertrophy, typically involving
    septum more than free wall, with or without an
    intraventricular systolic pressure gradient;
    usually of a nondilated left ventricular cavity.

    LABORATORY EVALUATION OF THE CARDIOMYOPATHIES


    Dilated
    Chest
    roentgenogram
    Electrocardiogram

    Moderate to marked cardiac


    silhouette enlargement
    Pulmonary
    venous
    hypertension
    ST-segment and T-wave
    abnormalities
    Left ventricular dilatation
    and dysfunction

    Restrictive
    Mild cardiac
    enlargement

    Hypertrophic

    silhouette Mild to moderate cardiac silhouette


    enlargement

    Low voltage, conduction


    defects
    Echocardiogram
    Increased left ventricular
    wall thickness
    Normal or mildly reduced
    systolic function
    Radionuclide studies Left ventricular dilatation Normal or mildly reduced
    and dysfunction
    systolic function
    Cardiac
    Left ventricular dilatation Normal or mildly reduced
    catheterization
    and dysfunction
    systolic function
    Elevated left- and often Elevated left- and rightright-sided filling pressures sided filling pressures
    Diminished cardiac output

    ST-segment
    and
    T-wave
    abnormalities
    Asymmertric septal hypertrophy
    Systolic anterior motion of the mitral
    valve
    Vigorous systolic function
    Perfusion defect
    Vigorous systolic function
    Dynamic left ventricular outflow
    obstruction
    Elevated left- and right-sided filling
    pressures

    Medication
    Loop diuretics
    Furosemide
    Bumetanide
    Torsemide
    Supplemental thiazides
    Metolazone
    Hydrochlorthiazide
    Chlorthalidone

    Common Medications for Heart Failure


    Initial Dose

    Maximum Dose

    20-40 mg 1-2 times daily PO;


    400 mg/d; 80 mg IV
    20 mg IV
    0,5-1,0 mg 1-2 times daily PO; 10 mg/d; 2 mg IV
    0,5 mg IV
    10 mg 1-2 times daily PO;
    200 mg/d; 20 mg IV
    5 mg IV
    2,5 mg 1-2 times daily
    25 mg/d
    50 mg/d

    Spironolactone
    (only 25 mg/d or every other day
    with loop diuretics

    10 mg/d
    100 mg/d
    100 mg/d
    25 mg twice daily,
    occasionally higher for
    refractory hypokalemia

    Angiotensin-converting
    enzyme inhibitors

    6,25 mg/d or every other day


    2,5 mg twice daily
    5-10 mg/d
    2,5-5,0 mg/d
    10 mg twice daily
    1,25-2,5 mg/d

    50-100 mg 4 times daily


    10-20 mg twice daily
    40 mg/d
    20-40 mg/d
    40 mg twice daily
    10 mg/d

    Bisoprolol
    Carvedilol
    Metoprolol tartrate
    Metoprolol
    succinate
    CR/XL

    1,25 mg/d
    3,125 mg twice daily
    6,25 mg twice daily
    12,5-25 mg/d

    10 mg/d
    25-50 mg twice daily
    75 mg twice daily
    200 mg/d

    Digoxin

    0,125 mg every other day to 0,25 mg/d

    Captopril
    Enalapril maleate
    Fozinopril sodium
    Lisinopril
    Quinapril hydrochloride
    Ramipril

    b-Blockers

    Other vasodilators
    Isosorbide dinitrate
    Sublingual isosorbide

    Hydralazine

    0,50 mg/d to avoid toxic effects

    10 mg 3 times daily
    80 mg 3 times daily
    2,5 mg as occasion requires or prior
    to exercise to decrease dyspnea
    25 mg 3 times daily
    150 mg 4 times daily


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