Physiology and Pharmacology
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show | under perfusion of:
Tissues - acidosis
Brain - lethargy, cerebral damage
Kidneys - acute tubular necrosis, renal failure
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show | Cardiac failure - chronic, ischaemic - reduction in CO to the point that it does not satisfy requirements
Hypovolaemia - actual e.g. haemorrhage or functional e.g. vasodilation
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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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Effects of ischaemia on frank starling curve | show 🗑
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show | Increased oxygen demand when this cannot be met - tachycardiac or increased contractility
Reduced oxygen supply - coronary atherosclerosis and small vessel disease
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Other causes of hypoxia | show 🗑
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Circle of cardiac failure | show 🗑
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Consequences of ischaemia | show 🗑
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show | Positive inotropic agent - with no increase in oxygen demand
Cheat - vasodilate to increase cardiac output and limit work to match cardiac oxygen
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Treatments for failure | show 🗑
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show | Must increase cardiac output
Oxygen demand less critical - may use ion pumping and increase oxygen supply
Must not vasodilate
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show | Sympathomimetics
Glycosides
Calcium sensitising agents
Indirect - vasodilators
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show | Increased calcium all the time - cannot be taken up into SR
Reduced contractility as less Ca to release and stiff walls
Increased diastolic pressure
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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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show | vasodilators - for chronic ischaemic failure
Vasoconstrictors for acute shock
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show | Sympathetic stimulation - direct or indirect
Altered contractile mechanism - calcium sensitization
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Phosphodiesterase inhibitors | show 🗑
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show | Tachycardia
Increased cardiac contractility
Splanchnic vasoconstriction
Skeletal muscle vasodilation at low conc and vasoconstriction at high conc - saturates beta due to high affinity then see alpha effects due to higher potency
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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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Dopamine analogues | show 🗑
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Calcium sensitizers | show 🗑
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Glycoside actions | show 🗑
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Mechanism of glycosides | show 🗑
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Endogenous glycosides | show 🗑
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Endogenous inotropes | show 🗑
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