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CO = HR x SV
Preload
Afterload
Contractility
Blood Volume
Distribution of
blood volume
Atrial Kick
Intrapericardial
pressure
LV Function
PRELOAD
Hemorrhage
Dehydration
Burns
Overdiuresis
Third Spacing
Hypervolemia
Overhydration
CHF
Renal disease
Altered Size of
Vascular Space
Sepsis
Spinal or epidural
anesthesia
Anaphylaxis
Venous dilating drugs
NTG
ACEI, ARBs
Nesiritide
Sympathetic NS
Arteriolar Tone
SVR
Aortic Pressure
& Compliance
Aortic Stenosis
HOCM
AFTERLOAD
Vasoconstriction
Sepsis
Spinal or epidural
anesthesia
Anaphylaxis
Arterial dilating drugs
Nipride
ACEI, ARBs
Nesiritide
Milrinone
Ca++ channel blockers
Antihypertensives
SNS Adrenals
Ventricular
Muscle Mass
Catecholamines
Hypertension
Compensatory
vasoconstriction
Drugs
Neosynephrine
Phenylephrine
Levophed
High-dose dopamine
Epinephrine
Vasopressin
H+ CO2 O2
Metabolic
State
Drugs
CONTRACTILITY
Increase
Pheocromocytoma
Hyperthyroidism
Positive inotropic drugs
Dobutamine
Dopamine
Levophed
Milrinone
Digoxin
Myocardial infarction
Cardiomyopathy
Ischemia
Hypoxia
Acidosis
Negative inotropic drugs
Beta blockers
Ca++ blockers
Antiarrhythmics
Some chemo agents
Some anesthetics, sedatives
Therapy to Alter CO
CO = HR X SV
Atropine
Epinephrine
Pacing
Beta blockers
Ca++ blockers (diltiazem, verapamil)
Antiarrhythmics
Adenosine
Digoxin
CO = HR X SV
Preload
Afterload
Contractility
Diuretics
Venous Dilators:
NTG
ACEI
ARBs
Nesiritide (Natrecor)
Morphine
Fluids
Blood products
CO = HR X SV
Preload
Afterload
Arterial Dilators:
Nitroprusside (Nipride)
Milrinone (Primacor)
Ca++ blockers
Antihypertensives
ACEI
ARBs
Nesiritide (Natrecor)
Contractility
Vasopressors:
Levophed
Dopamine (high dose)
Epinephrine
Neosynephrine
Vasopressin
CO = HR X SV
Preload
Afterload
Dobutamine
Dopamine
Milrinone
Digoxin
Contractility
Beta blockers
Ca++ blockers
Antiarrhythmics
Chemo agents
Anesthetics
Propofol
Heart Rate
CO
paO2
Preload
Hb, Hct
Contractility
Afterload
Afterload
Supply
Contractility
O2
Drugs to
blood
flow
Open
occluded
coronaries
NTG
Ca++ blockers
ASA
Platelet inhibitors
Anticoagulants
Angiomax
Thrombolytics
PTCA
Stents
Atherectomy
Rotablation
CABG
Parasympathetic:
Slows HR
Slows AV conduction
Sympathetic:
Speeds HR
Speeds AV conduction
Increases contractility
Beta Receptors
Isoproterenol
Beta 1
Neosynephrine
(Heart)
Dobutamine
Vasoconstriction
Dopamine
Epinephrine
Levophed
Beta 2
(Arteries, Veins)
(Lungs)
contractility
Vasodilation
heart rate
Bronchodilation
automaticity
conduction velocity
Renin release
Nephron
Pressure sensitive
cells are located
where the renal
tubule touches the
afferent arteriole
In response to
decreased renal blood
flow (whatever the
cause) renin is released
from these pressure
sensitive cells. Renin
initiates the reninangiotensin-aldosterone
cascade (next slide)
Renin-Angiotensin System
Renal blood flow
Renin release
Angiotensinogen
Angiotensin I
(converting enzyme)
Angiotensin II
Vasoconstriction
Aldosterone release
Na+ & H2O retention
More pressure
More Volume
10
Renin-Angiotensin System
Renal blood flow
Renin release
Beta Blockers
Angiotensinogen
Angiotensin I
Angiotensin II
ARBs
Vasoconstriction
Aldosterone release
Aldosterone Blockers
BP = CO X SVR
Increased Pressure
on baroreceptors
Inhibits vasomotor
center
Stimulates vagus nerve
( heart rate)
Decreased Pressure
on baroreceptors
Stimulates vasomotor
center
Inhibits vagus nerve
( heart rate)
Decreases BP
Increases BP
11
BP = CO x SVR
Drugs to SVR
Drugs to CO
Diuretics
(hydralazine, minoxidil)
ACEI, ARBs
PDE inhibitors (milrinone)
Calcium Channel Blockers
Aldosterone Blockers
(pines)
Drugs to SVR
Inotropes
- Dobutamine
- Dopamine
- Milrinone
- Digoxin
Vasopressors
- Levophed
- Neosynephrine
- Vasopressin
- Epinephrine
- Dopamine (high dose)
Volume
12
Pathogenesis of ACS
Plaque rupture
Platelet activation
Platelet aggregation
Plavix
ASA
IIb/IIIa Inhibitors
13
IIb-IIIa Inhibitors
Reopro
Integrilin (eptifibatide)
Aggrastat (tirofiban)
14
Phase 2:
Plateau
Ca++
Phase 0:
Depolarization
K+
Phase 3:
Repolarization
Na+
TP
Phase 4: TRP
3
Class III:
Class I:
Na+ Channel Blockers0
TP
K+
Channel Blockers
TRP
15
Class
Examples
IA
Quinidine
Procainamide (Pronestyl)
Disopyramide (Norpace)
IB
Lidocaine
Mexilitine
IC
Propafenone (Rhythmol)
Flecainide (Tambocor)
II
III
IV
Speed AV
Conduction:
Atropine
Epinephrine
Slow AV Conduction:
Beta blockers
Ca++ blockers
Adenosine
Digoxin
Vagal Maneuvers
Amiodarone
Ibutilide (Corvert)
Dofetilide (Tycosin)
16
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