21-31 - Heart Failure

Question 1

bowditch phenomenon

Answer 1

icnreases in heart rate cause an increase in contractility ( saves CO - filling time issues)

Question 2

frank-starling mechanism

Answer 2

increases in preload increase the contractility

Question 3

Anrep =

Answer 3

if you increase the afterload, contractility will increase

Question 4

in the excited state ____- preload is needed to increase SV because of changes in contractility

Answer 4

smaller preload to get same increase in SV

Question 5

main cause CHF

Answer 5

cardiac remodeling

Question 6

high risk for developing HF

Answer 6

stage A

• HTN
• CAD
• DM
• family hx

Question 7

asymptomatic HF

Answer 7

stage B

• previous MI
• LV systolic dysfunction
• asymptomatic valvular disease

Question 8

symptomatic HF

Answer 8

stage C

• known structural heart disease
• SOB and fatigue
• reduced exercise tolerance

Question 9

refractory end-stage HF

Answer 9

stage D

• marked symptoms at rest despite maximal medical therapy

Question 10

drug at all stages of HF

Answer 10

ACEi or ARB

Question 11

drug starting at stage B of HF

Answer 11

b- blocker

added to ACEi or ARB

Question 12

drug starting at stage C of HF

Answer 12

lots, notably Diuretics and Digoxin added to ACEi or ARB

Question 13

symptomatic HF, african-american race

Answer 13

hydralazine and nitrates and ACEi and B blocker

Question 14

symptomatic HF with afib

Answer 14

digoxin
ACEi
b-blocker

Question 15

drug that is bridge to transplantation or end of life

Answer 15

positive ionotropes

Question 16

4 practical approaches to increase intrinsic myocardial contractility

Answer 16

1. increase cytosolic Ca2+
2. increase myocardial cAMP
3. agonism of B1 receptors
4. increase B1 receptor density

Question 17

what drugs increase B1 receptor density?

Answer 17

b1 adrenergic antagonists

Question 18

example b adrenergic agonists

Answer 18

dobutamin, epinepthrin, NE, dopamine

Question 19

what drugs increase myocardial cAMP

Answer 19

phosphodiesterase inhibitors

amrinone, milrinone

Question 20

what drugs increase cytosolic Ca2+

Answer 20

cardiac glycosides

digoxin

Question 21

MOA digoxin

Answer 21

blocks Na/K ATPase to increase intracellular sodium and extracellular Ca2+

Question 22

positive ionotropic effects of digoxin

Answer 22

decrease EDV and ESV

decrease systemic and pulmonary venous pressure

decrease SANS

Question 23

digoxin has a ____ vagal effect

Answer 23

direct –> increases vagal tone

Question 24

how does digoxin affect coronary flow

Answer 24

increases it (by decrease hypertrophy)

Question 25

adverse effect of digoxin

Answer 25

proarrhythmic

need to watch K levels

Question 26

pharmacokinetics of digoxin

Answer 26

7 days to reach steady state

excreted by kidney

Question 27

what inactivates digoxin

Answer 27

eubacterium lentum

and cimetidine

Question 28

early sign of difitalis intoxication

Answer 28

anorexia, nausea, vomiting, visual change

you will see arrhythmia later

monitor K values!

Question 29

does digoxin improve mortality?

Answer 29

no

Question 30

I gave the pt too much digoxin - help!

Answer 30

cholestyaramin or digoxin immune Fab

Question 31

MOA phsophodiesterase 3 inhibitors

Answer 31

block type III phosphodiesterase activity leading to an incrrease in caMP and –> vasodiltation, positive ionotropic and lusitropic effects

Question 32

phosphodiesterase 3 inhibitors work downstream of what drug

Answer 32

b agonsits

Question 33

what are the two phosphodiesterase 3 inhibitors?

Answer 33

inamrinone

milrinone

Question 34

how do inamrinone and milrinone increase CO?

Answer 34

• directly stimualte myocardial contractility
• accelerate relaxation
• balance arterial and venous dialtion to decrease filling pressure

Question 35

indication for inamrinone and milrinone

Answer 35

short term circulation support in advanced CHF