For our beloved student

1. Heart Failure

2.  Heart failure is a condition in which
the heart can't pump enough blood to meet the
body's needs.
 Heart Failure is a condition in which the heart is
unable to pump enough blood to meet the
body's needs for blood and oxygen. Heart
failure usually results in an enlarged heart.
Heart failure can be ongoing (chronic), or the
condition may start suddenly (acute).
Congestive heart failure (CHF) is a chronic
progressive condition that affects the pumping
of heart.

3.  Angina is chest pain or discomfort caused when your
heart muscle doesn't get enough oxygen-rich blood. It
may feel like pressure or squeezing in your chest.The
discomfort also can occur in your shoulders, arms, neck,
jaw, or back. Angina pain may even feel like indigestion.
 But, angina is not a disease. It is a symptom of an
underlying heart problem, usually coronary heart
disease (CHD).There are many types of angina,
including microvascular angina, Prinzmetal's angina,
stable angina, unstable angina and variant angina.

5. Heart Attack: when the blood supplying
oxygen to the heart muscle is severely
reduced or stopped.
This happens because coronary arteries that
supply the heart can slowly become thicker
and harder as a result of fat, cholesterol and
other substances, called plaque. This slow
process is known as atherosclerosis.

8.  Pressure, tightness, pain, or a squeezing or
aching sensation in your chest or arms that
may spread to your neck, jaw or back.
 Nausea, indigestion, heartburn or abdominal
pain.
 Shortness of breath.
 Cold sweat.
 Fatigue.
 Lightheadedness or sudden dizziness

9. The most common signs and symptoms of
heart failure are:
 Shortness of breath
 Fatigue (tiredness)
 Swelling in the ankles, feet, legs, abdomen,
and veins in the neck.

10. Hydralazine
emergency

11.  Cardiac glycosides are organic compounds
containing a glycoside. Cardiac glycosides
represent a family of compounds that are
derived from the foxglove plant (Digitalis
purpurea)
 Examples: digoxin, and digitoxin

12. Digoxin inhibits the sodium potassium
adenosine triphosphatase (Na+/K+ ATPase),
mainly in the myocardium. This inhibition
causes an increase in the intracellular calcium
concentration that is available to the
contractile proteins.
Effect of potassium on digoxin toxicity(self
study)

14.  Once in the heart, digoxin binds to the Na+/K+ ATPase
pumps and inhibits their activity. This causes the
intracellular Na+ concentration to increase. This increase
in Na+ cause the Na+/ Ca2+ exchange pump to operate in
reverse. (Note :In the absence of digoxin this pump works
by bringing 3 Na+ from outside of the cardiac myocyte
into the myocyte and in exchange it would take a Ca2+
from inside the myocyte and move it outside the cell.
 Therefore, a greater concentration of cytosolic Ca2+
occurs inside the cell with digoxin, thereby allowing for a
greater degree of binding to troponin C and eventually
myosin/actin binding thus allowing for a greater force of
contraction (or inotropy).

16. Heart Failure
 ↑ inotropy
 ↑ ejection fraction( measurement of the
percentage of blood leaving heart each time
it contracts)
 ↓ preload(preload is the end diastolic volume
that stretches the right or left ventricle of the
heart)
 ↓ pulmonary congestion/edema

17.  Common side effect
 Digoxin Side Effects
 You should tell your doctor if any of the following side
effects become severe or don't go away:
 Dizziness
 Changes in mood and mental alertness, including
confusion, depression and lost interest in usual activities
 Anxiety
 Nausea, vomiting and diarrhea
 Headache
 Rash
 Growth or enlargement of breast tissue in men
(gynecomastia)
 Weakness

18.  Serious Side Effects of Digoxin
 Changes in heart rhythm, including irregular
heartbeat
 Fast or racing heartbeat
 Heart stopping or flat-lining (asystole)
 Problems with electrical functioning of the heart
known as heart block
 Visual problems, including blurry vision and
yellow halos
 Low platelet count

19.  Wolff-Parkinson-White syndrome (WPW)

 Wolff-Parkinson-White (WPW) syndrome is a
condition in which there is an extra electrical
pathway in the heart.The condition can lead
to periods of rapid heart rate (tachycardia).

20.  Milrinone is a phosphodiesterase-3 inhibitor.
This drug inhibits the action of
phosphodiesterase-3 and thus prevents
degradation of cAMP. With increased cAMP
levels there is an increase in the activation of
PKA(Protein Kinase A). This PKA will
phosphorylate many components of the
cardiomyocyte such as calcium channels and
components of the myofilaments. This increase
in calcium influx results in increased
contractility.

26.  thank you