An older female adult has severe ischemic heart disease, hypertension, and low cardiac output. Which medication does the nurse administer to counteract the neurohormonal ac-tivation due to the patient's cardiovascular status?
a. Loop diuretic
b. Nitroglycerin
c. Cardiac glycoside
d. Beta-adrenergic blocker
D
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A Incorrect. A diuretic is a part of standard therapy for heart failure for controlling fluid balance but it does not interrupt neurohormonal activation from heart fail-ure.
B Incorrect. Nitroglycerin is common therapy for an ischemic myocardium to in-crease myocardial oxygenation, but it does not interrupt the neurohormonal ac-tivation from heart failure.
C Incorrect. Digoxin, a cardiac glycoside, is a part of standard heart failure therapy and acts as an inotropic agent to increase the force of myocardial contractions; however, it does not interrupt neurohormonal activation from heart failure.
D Correct. A beta-adrenergic blocker is an important part of standard therapy for patients with heart failure and is the drug of choice to break the neurohormonal cycle that aggravates heart failure. The beta blockers inhibit the action of epi-nephrine (epi) and norepinephrine (NE) to decrease myocardial workload and lower myocardial tissue oxygen demands. This woman's heart is an ineffective pump because it is ischemic, so it is unable to meet the body's metabolic de-mands. An ischemic heart has difficulty obtaining the supply of oxygen it needs to maintain cardiac output. As a result, the hypoxic myocardium stimulates the sympathetic nervous system to release epi and NE for shunting blood from the periphery to vital organs, the fight or flight mechanism. The release of epi and NE causes vasoconstriction and subsequent hypertension. These make the work of the heart more difficult because the heart must work harder to pump blood out of the left ventricle against a higher afterload. The extra work increases myocardial tissue oxygen demands and augments the cycle started by the ischemic heart.
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