cardiotonic – a. 强心的，n. 强心剂
inotropic – a. 变力性的
nitrate – n. 硝酸盐
cardiac workload – 心肌工作负荷
afterload – n. 后负荷
preload – n. 前负荷
positive inotropic effect – 正性肌力作用
Human B-type natriuretic peptides -- 人B型钠尿肽
nesiritide – n. 奈西立肽 Natrecor – n.【奥】奈特瑞科
Digibind – n. 地高辛抗体Fab片段 注：带“【奥】”标记者为奥医临时用名，只为方便学员复习记忆，不得作为临床诊疗依据！
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HF Treatments 心衰治疗
Several different approaches are used to treat HF, including cardiotonic drugs (also called inotropic drugs) that work to directly increase the force of cardiac muscle contraction and the HCN blockers which alter the heart’s pacemaker and slow heart rate.
多种不同方式可用于治疗心衰，包括强心类药（又称变力性药）和HCN阻滞剂，前者药直接增强心肌收缩力，后者改变心脏起搏器，减缓心率。
Other drug therapies used to treat HF include the following:
用于治疗心衰的其他药物疗法包括如下：
l Vasodilators, such as angiotensin-converting enzyme (ACE) inhibitors and nitrates, decrease cardiac workload, relax vascular smooth muscle to decrease afterload, and allow pooling in the veins, thereby decreasing preload of the heart and helping to improve function. In 2005 a combination drug containing a nitrate and vasodilator was approved specifically for treating HF in African American patients. In 2015, another combination drug was approved for treating HF. Diuretics decrease blood volume, which decreases venous return and blood pressure, resulting in decreased afterload, preload, and cardiac workload.
l Beta-adrenergic agonists stimulate the beta receptors in the sympathetic nervous system, increasing calcium flow into the myocardial cells and causing increased contraction, a positive inotropic effect. Other sympathetic stimulation effects can cause increased HF because the heart’s workload is increased by most sympathetic activity.
l Human B-type natriuretic peptides are normally produced by myocardial cells and brain cells as a compensatory response to increased cardiac workload and increased stimulation by the stress hormones. They bind to endothelial cells, leading to dilation and resulting in decreased venous return, peripheral resistance, and cardiac workload. They also suppress the body’s response to the stress hormones, leading to increased fluid loss and further decrease in cardiac workload. Nesiritide (Natrecor) is the only drug currently available in a class of drugs called human B-type natriuretic peptides.
1. Which of the following are NOT typical signs and symptoms of right-sided heart failure? Select-all-that-apply.
A. Jugular venous distention
B. Persistent cough
C. Weight gain
D. Crackles
E. Nocturia
F. Orthopnea 2. A patient taking Digoxin is experiencing severe bradycardia, nausea, and vomiting. A lab draw shows that their Digoxin level is 4 ng/mL. What medication do you anticipate the physician to order for this patient?
A. Narcan
B. Aminophylline
C. Digibind
D. No medication because this is a normal Digoxin level.
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答案 Answer 1. B, D, and F. Rationale: Persistent cough, crackles (also called rales), and orthopnea are signs and symptoms of LEFT-sided heart failure...not right-sided heart failure. 2. C. Rationale: The patient is experiencing Digoxin toxicity...therefore the physician will order the antidote for Digoxin which is Digibind.
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