Physiology and Pharmacology
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| Effects of reduced cardiac output | show 🗑
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| Uses of positive inotropes | show 🗑
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| Effects of cardiac failure | show 🗑
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| show | Hypovolaemic shock - haemorrhage
Septic shock - toxic vasodilation
Cardiogenic shock - myocardial infarction
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| Influences on cardiac output | show 🗑
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| show | Shifts downwards
Decreased coronary blood supply, decreased oxygen availability
Decreases cardiac output for a given venous return
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| Causes of ischaemia | show 🗑
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| show | Reduced oxygen carriage - anaemia
Reduced oxygen exchange - asthma and COPD
Does not cause build up of CO2 so does not disturb H and K gradients
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| show | Fall in cardiac contractility
Fall in cardiac output
Fall in coronary perfusion
Cardiac ischaemia
Circle repeats
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| Consequences of ischaemia | show 🗑
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| Treatment of ischaemic failure | show 🗑
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| Treatments for failure | show 🗑
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| Treatments for shock | show 🗑
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| Positive inotropes | show 🗑
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| Effects of ischaemia on contractility | show 🗑
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| show | Increased Ca in systole as more taken up into SR
Increased contractility as more Ca to be released
Decreased diastolic pressure
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| Alternative approaches | show 🗑
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| show | Sympathetic stimulation - direct or indirect
Altered contractile mechanism - calcium sensitization
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| show | Phosphodiesterase breaks down the second messenger of adrenaline signalling at beta receptors
Inhibiting this via methyl xanthines e.g. aminophylline and theophylline increase the effects of sympathetic stimulation
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| Adrenaline effects | show 🗑
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| show | Increased cardiac output - beta 1 adrenergic
Generalised vasoconstriction - alpha adrenergic and dopaminergic
Vasodilation of gut and kidney - dopaminergic
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| show | Dobutamine - act via beta 1 receptors to increase contractility with limited vascular effects
Dopexamine
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| show | Levosimendan - binds to TnC
Omecamtiv - myosin activator
These increase contractility with no increase in ion pumping - although do have small effects
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| Glycoside actions | show 🗑
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| show | Inhibit Na K pump
Removes Na gradient
Stops removal of Ca via Na Ca exchanger
More Ca remains in cell to be taken up by SR
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| Endogenous glycosides | show 🗑
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| show | Glycosides
Apelin - don't fully know role in cardiac failure but seems to be absent - potential treatment option
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