Cardiovascular Drugs

Cardiovascular Drugs Prof / Usama Roshdy El Safy Professor of Paediatrics 2011 www.usamaelsafy.name.eg

Assessment of Cardiovascular Function www.usamaelsafy.name.eg

Health History Elicit a description of present illness and chief complaint Include: • Onset • Course • Duration • Location • precipitating and alleviating factors www.usamaelsafy.name.eg

Common Symptoms Of Cardiovascular Disease • Chest discomfort or pain • Palpitations • Syncope • Fatigue • Dyspnea • Cough, hemoptyosis • Weight gain • Edema • Nocturia www.usamaelsafy.name.eg

Chest Discomfort/Pain • One of the most important manifestations of cardiac ischemia • Other causes – pulmonary embolus, GERD, esophageal spasm • Assume chest discomfort is related to ischemia unless proven otherwise, especially if risk factors or history of CAD • Little correlation between severity of pain and gravity of situation www.usamaelsafy.name.eg

Palpitations • Dysrhythmias or arrhythmias • Causes • Stress, caffeine, drugs • Myocardial ischemia • Mitral valve disease • Electrolyte imbalances • Ventricular aneurysm • Ask about “skipped’ beats, irregular beats, fluttering, racing • Inquire about dizziness or fainting www.usamaelsafy.name.eg

Syncope or Changes in Mentation • Common causes • Stroke • Hypovolemia • Orthostatic hypotension • Seizures • Dysrhythmias • Hypoglycemia • Inquire about associated symptoms www.usamaelsafy.name.eg

Fatigue • Easy fatigability with mild exertion is common • Other causes • Anemia • Depression • Chronic diseases • Thyroid dysfunction www.usamaelsafy.name.eg

dyspnea • Often associated with myocardial ischemia • Primary symptom of pulmonary congestion from LV failure • Other causes • Fever • Anemia • Pulmonary disorders • Obesity • Different forms of dyspnea • Exertional dyspnea (DOE) • Orthopnea • Paroxysmal nocturnal dyspnea (PND) www.usamaelsafy.name.eg

Cough and Hemoptysis • Cardiovascular causes • Heart failure • Pulmonary edema • ACE inhibitors • Ask about the quality • Ask about frequency • If hemoptysis present, ask if streaks of blood, pink tinged www.usamaelsafy.name.eg

Weight Gain, Dependent Edema and Nocturia • As heart fails, fluid accumulates • Increase of 3 lbs or more in 24 hr is fluid accumulation • Inquire about weight gain, fitting of shoes, or tightening of clothes around waist • Nocturia - kidneys inadequately perfused by weak heart and receive increased blood flow during night – output increases www.usamaelsafy.name.eg

Past Medical History • Inquire about previous illnesses • Rheumatic fever, autoimmune diseases • Diabetes, kidney disease, HPN, dyslipidemia • Lung disorders • Clotting disorders • Explore previous hospitalizations and surgeries • Evaluate use of medications, OTC drugs, herbs, recreational drugs • Are meds taken as prescribed • Financial problems • Knowledge about meds • Any allergies www.usamaelsafy.name.eg

Family Health History • Inquire about diabetes, kidney disease, stroke, heart disease, hypertension (HPN) • Inquire about health of parents and siblings www.usamaelsafy.name.eg

Psychosocial History • Education • Occupation • Marital status, children and relationships • Coping and stress tolerance • Health habits – diet, exercise, smoking, alcohol use www.usamaelsafy.name.eg

Cardiovascular Drugs • Hypertension (high blood pressure) • Angina (heart attack) • Congestive heart failure • Arrhythmias • Cholesterol lowering • Blood disorders (anticoagulant, antiplatelet, thrombolytic) • Anemias, hemophilia www.usamaelsafy.name.eg

Primary (essential) HT Vast majority (90-95%) No identifiable underlying cause Commonly treated with drugs and lifestyle changes (exercise, diet, ↓weight,↓stress, quit smoking) Secondary HT Caused by identifiable underlying condition (renal artery disease, thyroid disease, pregnancy etc) Two basic types of hypertension www.usamaelsafy.name.eg

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Managing Hypertension • Confirm diagnosis • Assess underlying causes • Assess target organ damage • Appropriate therapy (non-pharmacological and pharmacological) www.usamaelsafy.name.eg

ANGINA PECTORIS (1) • Definition:recurring acute chest pain or discomfort resulting from ↓blood supply to the heart (myocardial ischemia). Pain often radiates to left arm • When: heart’s oxygen demand exceeds oxygen supply • Types: stable, unstable, variant, microvascular. • Triggers: emotional stress, extreme temperatures, heavy meals, alchohol, strenuous exercise, cigarette smoking www.usamaelsafy.name.eg

ANGINA PECTORIS (2) • Treatment: Controlling risk factors such as BP, cigarette smoking, high cholesterol levels, excess weight. Medications: nitrates (amyl nitrate or nitroglycerin), beta-blockers, calcium channel blockers (Surgery: cororany artery bypass / angioplasty—when severe and / or multiple artery disease) www.usamaelsafy.name.eg

Oxygen supply and demand www.usamaelsafy.name.eg

Anti-arrhythmic Drugs • An abnormality in the rhythm of the heartbeat • Two basic types of dysrhythmias • Tachydysrhythmias: heart rate is increased • Bradydysrhythmias: heart rate is slowed • Arrhythmias=Dysrhythmias www.usamaelsafy.name.eg

Cardiac conduction pathways. www.usamaelsafy.name.eg

Congestive Heart Failure (CHF) • Serious condition: heart’s pumping ability compromised. Unable to pump enough oxygenated blood with each contraction • Symptoms: shortness of breath (dyspnea)—initially only on exertion and later even at rest. Fluid retention • Causes: chronic damage to heart (heart valve diseases, high BP, viral infections, coronary artery disease etc) www.usamaelsafy.name.eg

Figure 47-1 Relationship of ventricular diameter to contractile force. www.usamaelsafy.name.eg

Drugs Used to Treat Heart Failure • Diuretics • Drugs that inhibit the renin-angiotensin-aldosterone system (RAAS) • Beta blockers • Digoxin and other cardiac glycosides • Inotropic agents (other than cardiac glycosides) • Vasodilators (other than ACE inhibitors and angiotensin-receptor blockers [ARBs]) www.usamaelsafy.name.eg

Cardiovascular Drugs