Cardiovascular Disorders and Pharmacological Management

Heart Failure (HF)

Heart failure occurs when the heart cannot pump enough blood to meet the body's metabolic needs. This leads to a decrease in cardiac output, stroke volume, and ejection fraction. The body often attempts to compensate through the renin-angiotensin-aldosterone system (RAAS), which can inadvertently increase workload by causing sodium and water retention.

Manifestations are often categorized by the side of the heart failing:

• Left-sided HF: Primarily pulmonary symptoms, such as crackles, dyspnea, and orthopnea.
• Right-sided HF: Systemic symptoms, including jugular vein distention (JVD), peripheral edema, and hepatomegaly.

Pharmacological Management of HF

• Lisinopril (ACE Inhibitor): Blocks the conversion of angiotensin I to II, reducing blood pressure and workload.

  Exam Tip: Monitor for the "ACE cough" and the rare but life-threatening complication of angioedema (swelling of the throat).

• Metoprolol (Beta-Blocker): Reduces heart rate and blood pressure. Hold administration if the heart rate is $<60$ bpm.
• Digoxin (Cardiac Glycoside): Increases contractility and slows heart rate.

  Toxicity Warning: Watch for visual changes (yellow-green halos), nausea, and vomiting.

• Milrinone (Phosphodiesterase Inhibitor): An inotropic agent given IV to increase contractility.

Hypertension (HTN) and Pregnancy-Related Complications

Hypertension is the consistent elevation of systemic arterial blood pressure. It is often called the "silent killer" because it may be asymptomatic until organ damage occurs.

Pharmacological Management of HTN

• Losartan (ARB): Blocks angiotensin receptors.
• Doxazosin (Alpha-1 Blocker): Causes vasodilation; monitor for the "first-dose phenomenon" (significant hypotension/syncope).
• Nifedipine (Calcium Channel Blocker): Used for HTN and angina.
• Hydralazine & Nitroprusside (Direct Vasodilators): Used for more acute or severe cases. Nitroprusside is reserved for hypertensive crises in critical care settings.

Hypertension in Pregnancy

Pregnancy introduces unique risks, specifically Preeclampsia and Eclampsia.

• Preeclampsia: Characterized by high blood pressure and protein in the urine during the second half of pregnancy.
• Eclampsia: A severe complication involving one or more seizures.
• Management: The definitive treatment is the delivery of the baby. Labetalol is considered a safe medication for blood pressure control during pregnancy.

Peripheral Vascular Disease (PVD) and Thromboembolism

Peripheral Vascular Disease involves impaired blood supply to the extremities, often due to atherosclerosis in the peripheral arteries. This can lead to intermittent claudication (pain during walking) and skin changes.

A critical complication of vascular issues is the formation of blood clots:

1. Deep Vein Thrombosis (DVT): A clot forming in a deep vein, often due to venous stasis, endothelial injury, or hypercoagulability (Virchow's Triad).
2. Pulmonary Embolism (PE): A life-threatening condition where a DVT detaches and travels to the pulmonary arteries, blocking blood flow to the lungs.

Pharmacological Management of Clotting Disorders

• Heparin (Anticoagulant): Used for immediate anticoagulation in DVT or PE. Monitor aPTT levels.
• Warfarin (Anticoagulant): A Vitamin K antagonist used for long-term prevention. Monitor INR (goal 2–3).

  Patient Education: Patients must maintain a consistent intake of Vitamin K-rich foods (like leafy greens) to avoid interfering with warfarin's effectiveness.