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Cardiology > 9.8.2013(Heart Failure) > Flashcards

9.8.2013(Heart Failure) Flashcards

0
Q

Stage A heart failure

A 
No symptoms
No structural disease 
Only risk factors present
  CAD
  hypertension
  DM
  toxins
  Cardiomyopathy
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1
Q

Precipitants of heart failure

A 
Infection
Volume overload
Thyroid dysfunction
Myocardial ischemia
Hypertension
Arrythmias
Alcohol
NSAID
CCB
doxorubicin
Pulmonary embolism
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2
Q

Rx of stage A heart disease

A

Dietary modifications
Treat hyperlipidemia
ACE inhibitors for HTN

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3
Q

Stage B heart failure

A

Abnormal LV systolic function
MI
valvular Heart disease
No symptoms

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4
Q

Rx of stage B heart failure

A

ACEI

beta blockers

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5
Q

Stage C heart failure

A

Structural HF with symptoms

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6
Q

Rx of stage C heart disease

A

ACEI
beta blockers
Diuretics
Digoxin

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7
Q

Stage D heart failure

A

Heart failure symptoms refractory to maximal medical management

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8
Q

Rx of stage D heart failure

A

Mechanical assist devices
Cardiac transplantation
Continuous IV inotropic support

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9
Q

BNP levels and heart failure

A

BNP>400 in the absence of renal failure is specific

BNP<100 has high negative predictive value

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10
Q

Testing to be done in new onset heart failure without CAD

A 
HIV
hepatitis
Hemochromatosis 
ANA,ANCA
Amyloidosis
Pheochromocytoma
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11
Q

Role of cardiac MRI in assessing heart failure

A 
Valvular disease
Amyloidosis
Sarcoidosis 
Myocarditis
Previous MI
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12
Q

Role of cardiopulmonary exercise testing in heart failure

A

Assessment for heart transplantation

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13
Q

Role of coronary angiography in heart failure

A

In pts with angina or evidence of ischemia in ECG or stress testing unless they are not candidates for revascularisation

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14
Q

Effects of beta blockers in heart failure

A

Improves ejection fraction,exercise tolerance,NYHA class

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15
Q

Time taken for improvement in LV function after instituting Betablocker therapy

A

2-3 months

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16
Q

Adverse cardiac effects immediately reduced after institution of Betablocker therapy

A

Arrythmias

Sudden cardiac death

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17
Q

Adverse reactions that may occur after initiation of Betablocker therapy

A

Volume retention and worsening of heart failure symptoms,these improve with use of diuretics

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18
Q

Beta blockers with proven benefit on mortality

A

Carvedilol
Metoprolol
Bisoprolol

19
Q

When should one be cautious when using vasodilators in heart failure

A

Diastolic dysfunction
Fixed cardiac output states
AS
HOCM

20
Q

Beneficial effects of ACE inhibitors in heart failure

A

Attenuate vasoconstriction,vital organ hypoperfusion,hyponatremia,Hypokalemia and fluid retention

21
Q

Use of ACE inhibitors in heart failure

A 
Improve systolic dysfunction 
Asymptomatic systolic dysfunction
CAD
DM
HTN
22
Q

Adverse effects of ACE inhibitors

A 
Renal insufficiency in B/L renal artery stenosis
Hyperkalemia
Rashes
Angioedema
Dysgeusia
Increased serum creatinine
Proteinuria
Leukopenia
Cough
23
Q

Agranulocytosis and angioedema is common in which ACE inhibitor

A

Captopril

Especially in pts with associated collagen vascular disease or Cr more than 1.5mg%

24
Q

Vasodilator combination that reduces mortality in heart failure

A

Hydralzine

Isosorbide dinitrate

25
Q

Preferred vasodilator for treatment of heart failure in acute MI or unstable angina

A

Nitroglycerin

26
Q

Use of sodium nitroprusside in heart failure

A

MR
AR
Hypertensives

27
Q

Thiocyanate toxicity

A 
Paresthesia
Nausea
Mental status changes
Abdominal pain
Seizures
28
Q

Toxic levels of Thiocyanate

29
Q

Sodium nitroprusside should be used with caution in myocardial ischemia because

A

Coronary steal phenomenon

30
Q

Side effects of nitroprusside treatment

A

Cyanide toxicity

Methhemoglobinemia

31
Q

Use of nesiritide

A

Acute heart failure exacerbations

32
Q

Contraindication for use of nesiritide

A

SBP less than 90mm of Hg

33
Q

Enlapril 2.5mg oral per day is equivalent to enlaprilat _______

A

0.625mg IV 6th hourly

34
Q

Role of alpha blockers in heart failure

35
Q

Therapeutic serum digoxin levels

A

0.8-2 ng/ml

36
Q

Dose of digoxin should be reduced in

A

Renal failure

37
Q

Drugs that increase digoxin levels

A 
ERYTHROMYCIN
TETRACYCLINE
Quinidine
Verapamil
Flecainide
Amiodarone
38
Q

Digoxin toxicity is enhanced by

A 
Hypokalemia
Hypoxemia
Hypothyroidism
Renal insufficiency 
Volume depletion
39
Q

Thiazide that is useful in pt with low GFR

A

Metolazone

40
Q

How lasix is useful in HF and acute pulmonary Edema

A

Reduces preload by causing direct venodilation

41
Q

Loop diuretics that can be safely used in Sulfa sensitive patients

A

Ethacrynic acid

42
Q

Role of spironolactone in heart failure

A

NYHA class III-IV pts with creatinine less than 2.5mg/dl and K+ less than 5mEq/L

43
Q

Role of milrinone

A

Refractory heart failure

44
Q

Maximum daily dose of frusemide

Cardiology (16 decks)

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