Pharmacological Management of Congestive Heart Failure药理充血性心力衰竭.pptVIP

Variable Measured Digitalis effect on Normal Heart Digitalis Effect on CHF Heart Contractility Increased -- direct effect of glycoside Increased -- direct effect of glycoside Heart Rate Decreased Bradycardia, due to vagal stimulation Decreased Bradycardia, due to reduction in sympathetic tone Vascular Resistance Increased: Direct vasoconstriction of blood vessels. Decreased: Improved cardiac function --- lost sympathetics --- vasodilation. Cardiac Output Unaffected: Improved cardiac performance is offset by vasoconstriction. Increased: because vascular resistance is improved in CHF CARDIAC GLYCOSIDES (DIGITALIS): Inotropic agents used for CHF. Pharmacological Effects: MECHANICAL ACTION on HEART 1 Increased myocardial contractility Increased Cardiac Output 2 AV Node: Increase risk of heart block Purkinje Fibers: Increase automaticity Parasympathomimetic Effects Hypokalemia 3 indirect -- resulting from improved cardiac output. If cardiac output does not improve, then there will be no diuresis ELECTRICAL ACTION on HEART KIDNEY DIURESIS ? Site of Action Electrophysiologic Effect ECG Change AV Node Prolonged refractory period -- slowed AV conduction Prolonged PR Interval (between atrial and ventricular systole), which can result in 1st degree heart block. Ventricle Changes in Phase 2 or 3 repolarization Changes in ST-Segment (depolarization), or T-Wave (repolarization). Flattening or inversion of T-Waves is often the first, most characteristic thing seen after a large digitalis dose. Ventricle Accelerated Repolarization, Increased automaticity Shortened QT Interval, due to increased automaticity. ? Electrophysiologic Effect INDICATIONS of DIGITALIS atrial fibrillation CHF paradoxical ventricular tachycardia PHARMACOKINETICS OF DIGITALIS  IV Administration:  Ouabain(哇巴因） or Digoxin （地高辛）can be administered IV for emergencies. They are diluted with saline solution and injected slowly. DIGITALIZATION:   Goal = attain