March 24, 2023

Role of Beta Blocker in CHF S(-) Metoprolol

Yeah hello friends once again well we need to continue with the role of beta-blockers in the management of and just a heart failure well what is the mechanism of action how do they act that is important for us to understand well first of all what exactly the beta-blockers do in patients with congestive heart failure is that they reduce or the decrease the heart

Rate secondly they increases it increases the diastole that is the period of relaxation is increased the soul once the diastole is increase or the period of relaxation is increased ventricular failure in time will also increase well this due to the increase in the diastole and the ventricular filling time there is no resultant stretch on the cardiomyocytes and

This red leads to an improved force of contraction of the myocardium hence it will improve your heart ache output but you need to be cautious that beta blockers can worsen the cardiac output hence they have to be prescribed with caution in cases of chf so to highlight it once again and for a better learning and remembering it decreases the heart rate it increases

The diastole it increases the ventricular filling time it improves the resultant stretch or it increases the resultant stress on the myocardium which improves the foc that is the force of contraction and which timidly improves your cardiac output so the role of beta blockers in congestive heart failure has to be used with a word of caution so we go on to the next

Slide what are the contraindications well as you are aware of in the previous slide we spoke that it reduces or it decreases the heart rate well what the contraindication to the use of blinka blockers well they should not be administered to patients with heart failure who bradycardia that is was heart rate is less than 60 beats per minute or the patient is having

Heart block or has a hemodynamically in stable condition so all these conditions are contraindications to beta blockers administration so now we go on to the next slide and we talk about the next disease which is there well heart blocks well they are known as atrial ventricular blocks as arise from the atrioventricular nose nodes so they cause bradycardia and there

Can be first-degree blocks that can be second-degree heart block and they can be third-degree heart block well the first degree heart rocks they manifest as pr prolongation that means in the ecg you will have t to our distance prolonged between the subsequent complexes then second-degree heart block means there is a tyke one in a second-degree heart block is also

Known as the mobitz one oven when he backs then you have type two second-degree heart block also known as mobitz ii then you have third-degree heart block which is also called as a complete heart block well these are the conditions where beta blockers are contraindicated because they are already in a state of bradycardia that means reduced heart rate well there is

A next disease which we are going to talk about is portal hypertension total refers to a patek and basically it is related to the system of nerves which have which are related to your hepatic system so whenever there is an elevation of hepatic venous pressure gradient to five millimeters of mercury or more than that spoiled-ass portal hypertension well generally

You don’t measure the portal pressures and for that you knew you use tips this is a way of t ips it is a method with which you measure the hyper ties you measure growth pressures in your portal veins well portal hypertension occurs when there is an obstruction to the blood flow through the liver and the pressure rises within the portal vein well this obstruction

Can be intra hepatic which means inside the liver it can be pre hepatic which means before the liver or it can be postive addict that is post means after the liver that means after the veins for two veins so it can be before the entry of the portal vein into the liver it can be after or it can be within the in within the liver itself what are the complications of

Portal hypertension well it can lead to of course failure that is liver failure it can lead to gi bleeds from swollen veins which are called as where isis gi bleeding from where isis that means swollen veins s itis it can lead to a situs that is accumulation of fluid in your abdominal cavity if add again careful opeth e that means again your functions of the brain

Are impaired you can have splenomegaly that means increase in the size of the spleen there can be anemia that means there will be a mismatch or there will be a between the demand and supply of oxygen then there might be leukopenia which means low wbc counts and of course thrombocytopenia which means low platelet counts all these are manifestations or complications

Of portal attention well what is the role of beta-blockers then here well beta-blockers they lower the cardiac output that means wire the blockade of beta 1 receptors and cause blank neck vasoconstriction which means they cause constriction of the vessels which supply your abdominal and this will reduce the portal and the collateral blood flow so once the portal

Blood flow and the collateral blood flow is reduced then it causes a reduction in your pressures so this is an important medication for treating portal hypertension well now we go on to the next disease which is called as hyperthyroidism well hyperthyroidism is a disorder that occurs when the thyroid gland makes more thyroid hormone than what the body needs it is

Also called as thyrotoxicosis for too much of thyroid hormone in the blood well thyroid hormones circulate throughout the body in the bloodstream and act on virtually every tissue and cell in the body hyperthyroidism causes many of the body’s functions to speed up these includes palpitations tachycardia tremulousness that means a person is having tremors at rest

Anxiety and heat intolerance which means the normal temperatures can be outside can be 22 degree centigrade and the and the patient is complaining of sweating an excessive heat wrong so that is he is intolerant to heat or to rising temperatures then i whatever what will be what are the three main hormones which are responsible for hypothyroidism or which help

The doctor diagnose hypothyroidism well the thyroid gland makes to thyroid hormones they are try i do tyron in there is t3 and thyroxine that is tetra hydro tyranny well t3 is made from t4 and is also more active hormone and directly affecting the tissues so thyroid hormone production as such is regulated by the tsh which is produced in the pituitary gland in

The brain so tsh produces or it sends signals to form t4 and t3 and from t4 the thyroid gland makes two hormones i have said t3 and t4 and t3 is made from t4 so it is t4 dissociates or breaks to form t3 then thyroid hormone levels in the blood are low the pituitary releases small tsh so if in your blood t3 and t4 are less then dss from the pituitary releases or

Stimulates the thyroid gland to produce more hormones when thyroid hormone levels are high the pituitary responds by decreasing tsh production so beta profits when the use of beta blockers in hyperthyroidism is that the emily rate the symptoms of hyperthyroidism then were caused by increased at unitec tone which means that to reduce your heart rate the tremors

And so the beta blockers emily rate means to reduce the symptoms of hypothyroidism which i have discussed in the previous slide so they are the first line of drugs in the treatment of hypothyroidism which can be followed by your normal thyroid drugs so once again to do aggregate what are the symptoms of hyperthyroidism well hyperthyroidism has many symptoms that

Can vary from person to person some common symptoms of hyperthyroidism are nervousness or irritability fatigue or muscle weakness heat intolerance trouble in sleeping and tremors rapid and irregular heartbeat frequent bowel movements or diarrhea weight loss mood swings well there is a condition called as goiter in which your thyroid gland is enlarged and that

May cause the neck to look swollen and can interfere with the normal breathing and swallowing so we just need to know what is going to so we know the symptoms we know why winter blockers are used in hyperthyroidism so it is a new indication so where we can go and promote met pure accel then i put our autism again how it is diagnosed well we have the symptoms of

Hypothyroidism as we have discussed and secondly there are some tests well there is a tsh test ts is the most accurate measure of thyroid activity available the tsh that is thyroid stimulating hormone test especially useful in detecting mild hyperthyroidism or tsh reading below normal means a person has hyperthyroidism and a reading above normal means a person is

Having hypothyroidism t3 and t4 test this test shows us the levels of t3 and t4 in the blood with hyperthyroidism the levels of one or both of these hormones in the blood are higher than normal so when they vent in case of hyperthyroidism when the levels are high tsh reading is you can see here below normal so t3 t4 on the higher side then tsh will be below normal

Or it can be normal and in case of hypothyroidism you want that the pituitary should work more so the readings are above the normal and your t3 t4 levels in the blood will be lower than the normal so it is just a opposite when we use the term hyperthyroidism then your t3 and t4 levels and this test shows that the levels of t3 t4 in blood so with hyperthyroidism

The levels of one or both of hormones in the blood are higher in their normal so t3 t4 levels are high in hyperthyroidism and dshs low opposite is the case with hypothyroidism i’m reinforcing and trying to read again try to explain you why this is happening well it is a blood in the blood you have t3 and t4 hormones and tsh is the hormone which is produced from

The pituitary so if you are in case of hyperthyroidism t3 3 4 values are higher so the signal is sent to your brain that we don’t need anymore so tsh activity is reduced so the tsh is less whereas in hypothyroidism these hormones are less in the blood that is t3 t4 values are less in the blood so it sends signal back to the brain we want more paranoid hormone so

The tsh value increases so in hypothyroidism and in hypothyroidism it is actually paradoxical so we need to just remember this understand it and you produce it whenever needed for the tests of course so how is hyper hyper thyroidism treated well the main aim of treatment is to bring thyroid hormone levels to a normal state thus preventing long term complications

And to relieve those uncomfortable symptoms like tachycardia intolerance to heat then we spoke about tremors and an inability to speak anxiety all these have to be controlled so the medications which reduce the symptoms of tremor dravid heartbeat nervousness anxiety are the beach’ blockers but do not stop thyroid hormone but but the only thing is that they don’t

Affect the thyroid hormone production so we need simultaneously anti thyroid medication too also so beta blockers along with an t thyroid medications are used to treat hyperthyroidism so with this i’ll probably end here today we can talk the different slides later about copd and we can discuss about it at a later time what i want you is to understand the thyroid

Disease the diagnostic test so that we are thorough witted so i wish you happy learning all the best

Transcribed from video
2 Beta Blocker in CHF S(-) Metoprolol By Suman Deb