CARDIOVASCULAR SYSTEMppt.pptx

Prolonged exposure of heart to alpha and beta

Info icon This preview shows pages 139–155. Sign up to view the full content.

PROLONGED EXPOSURE OF HEART TO ALPHA AND BETA RECEPTOR STIMULATION UNFORTUNATELY, PROMOTES LEFT VENTRICULAR MODELLING, CELL DEATH DUE TO NECROSIS OR APOPTOSIS AND WATER SALT RETENTION. 139
Image of page 139

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

BETA BLOCKERS INTERFERE WITH THE HARMFUL EFFECT OF SUSTAINED ACTIVATION OF THE ADRENERGIC NERVOUS SYSTEM BY COMPETITIVELY ANTAGONIZING ONE OR MORE ADRENERGIC RECEPTORS. WHEN GIVEN ALONG WITH ACE INHIBITORS BETA BLOCKERS REVERSE THE PROCESS OF RV REMODELLING , IMPROVE PATIENT SYMPTOMS, PREVENTS HOSPITALISATION AND PROLONGS LIFE. THEREFORE BETA BLOCKERS ARE INDICATED FOR PATIENTS WITH SYMPTOMATIC OR ASYMPTOMATIC HF AND DEPRESSED EJECTION FRACTION < 40%. 140
Image of page 140
THERE ARE THREE BETA BLOCKERS THAT HAVE BEEN SHOWN TO BE EFFECTIVE IN REDUCING THE RISK OF DEATH INPATIENTS WITH CHRONIC HF: - BISOPROLOL - METOPROLOL - CARVEDILOL 141
Image of page 141

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

383 142 Ans. is 'a' i.e., ACE + Beta Blocker [Ref Clinical Cardiology : Current Practice Guidelines]
Image of page 142
384 143
Image of page 143

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

"DIGITALIS TERM IS USED INDISCRIMINATELY, BY CONVENTION DIGITALIS IS APPLIED AS A COLLECTIVE TERM FOR THE WHOLE GROUP AND HAS COME TO MEAN A CARDIAC GLYCOSIDE“. DIGOXIN AND DIGITOXIN ARE TWO OF THE MANY TYPES OF CARDIAC GLYCOSIDES. DIGOXIN IS A POLAR GLYCOSIDE AND IS EXCRETED BY KIDNEY. IT DOES NOT UNDERGO HEPATIC METABOLISM WHILE DIGITOXIN UNDERGOES HEPATIC METABOLISM. 144
Image of page 144
ARRYHTHMIAS RESULTING FROM DIGITALIS TOXICITY ARE AN IMPORTANT AND LIFE THREATENING CLINICAL PROBLEM SEEN IN UPTO FIVE PERCENT OF THE PATIENTS RECEIVING DIGOXIN (DIGITOXIN). PLASMA DIGOXIN LEVELS: LIFE THREATENING DIGITALIS INDUCED ARRYHTHMIA OCCURS AT PROGRESSIVELY INCREASING FREQUENCY AS THE PLASMA DIGOXIN CONCENTRATION RISES ABOVE 2.0 NG/ML. HOWEVER SIGNS OF TOXICITY MAY OCCUR AT LOWER PLASMA LEVELS IN THE PRESENCE OF COMORBID CONDITIONS. 145
Image of page 145

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

ALMOST ANY ARRVHTHMIA OCCURRING AT ALMOST ANY INTRACARDIAC LOCATION CAN BE SEEN WITH DIGITALIS TOXICITY. THERE ARE HOWEVER SOME ARRVHTHMIAS THAT ARE GENERALLY NOT INDUCED BY DIGITALIS :- - ATRIAL FLUTTER - ATRIAL FIBRILLATION 146
Image of page 146
384 147 Ans. is 'a' i.e., Digoxin [Ref. Harrison ]18h /ep.2236, 2237, Kumar & Clarke 7t'/ep.3431
Image of page 147

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

148
Image of page 148
CHRONIC DIGITALIS INTOXICATION MAY BE INSIDIOUS IN ONSET AND CHARACTERIZED BY: EXACERBATIONS OF THE HEART FAILURE. WEIGHT LOSS . CACHEXIA. NEURALGIAS. GYNECOMASTIA. YELLOW VISION . DELIRIUM. 149
Image of page 149

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

389 150
Image of page 150
OTHER FACTORS PRECIPITATING DIGITALIS TOXICITY 1. ADVANCED AGE 2. ACUTE MYOCARDIAL INFARCTION OR ISCHEMIA 3. HYPOXEMIA 4. HYPOMAGNESEMIA 5. RENAL INSUFFICIENCY 6. HYPERCALCEMIA 7. ELECTRICAL CARDIOVERSION 8. HYPOTHYROIDISM 9. HYPOKALEMIA 151
Image of page 151

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

389 152 Ans. is 'd' i.e., Hepatic dysfunction [Ref Harrison 16th/ep. 1375, KDT 6th/e p. 497& 5th1ep. 462] Digoxin toxicity it is enhanced by renal failure as it is excreted through kidneys where as digitoxin toxicity is enhanced by liver failure because it is eliminated by hepatic metabolism.
Image of page 152
392 153
Image of page 153

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

MANAGEMENT OF DIGITALIS OVERDOSE: 1) WITHDRAWAL OF DRUG 2) POTASSIUM: - ADMINISTER CAUTIOUSLY AND BY ORAL ROUTE WHENEVER POSSIBLE IF HYPOKALEMIA IS PRESENT.
Image of page 154
Image of page 155
This is the end of the preview. Sign up to access the rest of the document.
  • Winter '16
  • jean grey
  • Cardiology, Ans., Constrictive pericarditis

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern