Cardiovascular diseases Flashcards
Heart failure
1
Q
What’s the difference between systolic and diastolic HF?
A
Systolic left<40
Diastolic >40
2
Q
Most common cause of systolic hf?
A
CHD
3
Q
Most common cause of Diastolic hf?
A
HTN
4
Q
What is heart failure?
A
A condition in which the heart is unable to pump sufficiently to maintain blood flow to meet the body’s needs.
5
Q
True or False: Diuretics are used to reduce fluid overload in heart failure patients.
A
True
6
Q
What does ACE stand for in ACE inhibitors?
A
Angiotensin-Converting Enzyme
7
Q
Which medication class helps to improve heart contractility in heart failure?
A
Positive inotropes
8
Q
Fill in the blank: Beta-blockers are often used in heart failure to reduce ________.
A
heart rate
9
Q
What is the primary action of diuretics in heart failure treatment?
A
To promote the excretion of sodium and water.
10
Q
True or False: Aldosterone antagonists can help prevent cardiac remodeling.
A
True
11
Q
What is the role of angiotensin receptor blockers (ARBs) in heart failure?
A
To block the effects of angiotensin II and reduce blood pressure.
12
Q
What is the mechanism of action of digoxin in heart failure?
A
It increases the force of heart contractions and decreases heart rate.
13
Q
True or False: All heart failure patients should be treated with the same medication regimen.
A
False
14
Q
What is the purpose of using nitrates in heart failure treatment?
A
To reduce preload and relieve symptoms of congestion.
15
Q
Which type of heart failure is characterized by preserved ejection fraction?
A
Heart failure with preserved ejection fraction (HFpEF)
16
Q
Name a side effect commonly associated with ACE inhibitors.
A
Cough
17
Q
What is the first-line treatment for heart failure with reduced ejection fraction (HFrEF)?
A
ACE inhibitors or ARBs
18
Q
Fill in the blank: ________ are used to prevent arrhythmias in heart failure patients.
A
Beta-blockers
19
Q
True or False: Heart failure medications can cure the condition.
A
False
20
Q
What is the benefit of using a combination of medications in heart failure treatment?
A
To target multiple pathways and improve overall heart function.
21
Q
Which medication class is known for causing hyperkalemia as a side effect?
A
Aldosterone antagonists
22
Q
What is the significance of monitoring renal function in heart failure patients on diuretics?
A
To prevent acute kidney injury.
23
Q
Fill in the blank: ________ inhibitors are beneficial in heart failure due to their vasodilatory effects.
A
ACE
24
Q
What does the term ‘cardiac remodeling’ refer to in heart failure?
A
Structural changes in the heart due to long-term pressure or volume overload.
25
Name one lifestyle modification recommended for heart failure patients.
Sodium restriction
26
True or False: Heart failure medications should be adjusted based on patient symptoms and tolerability.
True
27
You can use digoxin in diastolic hf?
False
28
First line in systolic HF to African American?
BB+ACE+hydralazine isosorbide
29
SE of thiazide diuretics?
Photosensitivity
30
Thiazide diuretics contraindication?
Cl<30
31
What loop diuretic is used if patient has sulfa allergy?
Ethacrynic acid
32
True or false
You can use thiazide with loop if senergy effect is needed even if cl <30?
True
33
What to monitor with loop diuretics?
K mg
34
When to avoid K_sparing diuretics?
K>5 , scr>2.5 , CrCl<30
35
What to do with spironolactone 25 if k >5.5
DC or reduce dose by 50%
36
Contraindications os ACE
Angioedema
37
Which ACE can be used for hepatic failure?
Lisinopril
38
True or false
Enalpril needs activation on liver?
True
39
List the common symptoms of Chronic Heart Failure (HF).
* Fatigue
* Shortness of breath
* Edema
40
What does NYHA stand for?
New York Heart Association
41
What is the NYHA Class IV classification?
Symptoms at rest
42
What is the relationship between NYHA Class I and Stage B?
Class I = Stage B
43
What is the relationship between NYHA Class IV and Stage D?
Class IV = Stage D
44
What medications must any systolic HF patient take?
* ACE inhibitors
* β-blockers
45
What should be used if a patient is unable to tolerate an ACE inhibitor?
ARBs
46
What should be used if a patient is unable to tolerate ARBs?
Hydralazine/isosorbide dinitrate
47
What is the action if symptoms persist with ACE inhibitors and β-blockers?
Add aldosterone antagonist (AA)
48
What should be done if aldosterone antagonist is not tolerated or indicated?
Replace it with ARBs
49
True or False: ACE inhibitors, ARBs, and aldosterone antagonists can be combined.
False
50
What medication can be added if symptoms still exist after using ACE inhibitors, β-blockers, and AA?
Digoxin (only if systolic HF)
51
When should Hydralazine/isosorbide dinitrate be added as initial therapy?
If African American NYHA class III or IV
52
What is the goal for weight loss in patients with systolic HF?
1-2 lb of weight loss per day
53
What should be monitored and replaced in patients with systolic HF?
K and Mg
54
What is the goal for potassium (K) levels in patients with systolic HF?
K ≥ 4.0 mEq/L
55
What is the goal for magnesium (Mg) levels in patients with systolic HF?
Mg ≥ 2.0 mEq/L
56
What diuretics are preferred if CrCl < 30?
Loop diuretics
57
List some examples of loop diuretics.
* Furosemide
* Bumetanide
* Torsemide
* Ethacrynic acid
58
What is the starting dosage for Spironolactone in NYHA Class III, IV?
12.5-25 mg
59
What is the starting dosage for Eplerenone in NYHA Class II, III, IV?
25-50 mg
60
What are the contraindications for using Aldosterone antagonists?
* SCr > 2.5
* CrCl < 30 mL/min
* K > 5
61
What should be done if potassium levels exceed 5.5?
Decrease dose by 50% or discontinue
62
What is the absolute contraindication for ACE inhibitors?
Angioedema
63
What should be monitored when using ACE inhibitors?
* BP
* SCr
* K every 1-2 weeks
64
What is the acceptable increase in SCr when using ACE inhibitors?
Less than 30% of baseline
65
What should be done if SCr increases by 30% or more when giving ACE?
Stop it or decrease the dose
66
What is the starting dosage for Captopril?
6.25 mg TID
67
What is the target dosage for Captopril?
50 mg TID
68
What is the starting dosage for Enalapril?
2.5 mg BID
69
What is the target dosage for Enalapril?
10 mg BID
70
What is the starting dosage for Lisinopril?
2.5-5 mg/day
71
What is the target dosage for Lisinopril?
20 mg/day
72
What is the starting dosage for Ramipril?
1.25-2.5 mg/day
73
What is the target dosage for Ramipril?
10 mg/day
74
What is the starting dosage for Furosemide?
40 mg
75
What is the bioavailability of Furosemide when given IV?
50%
76
What are the two classes of drugs discussed for compensated heart failure?
ACE inhibitors and ARBs
## Footnote
ACE inhibitors are superior if tolerated; ARBs have fewer side effects such as angioedema and cough.
77
What is the starting dosage of Candesartan for heart failure treatment?
8 mg/day
## Footnote
Target dosage is 32 mg/day.
78
What is the target dosage for Losartan in heart failure treatment?
150 mg/day
## Footnote
Starting dosage is 50 mg/day.
79
What is the starting dosage of Valsartan for heart failure treatment?
40 mg BID
## Footnote
Target dosage is 160 mg BID.
80
What effect do ACE inhibitors and ARBs have on heart oxygen needs?
They have a negative inotropic effect, decreasing heart needs for oxygen.
81
What should be done if a patient becomes hypotensive while on ACE inhibitors?
Decrease the ACE dose, not the beta-blocker dose.
82
What is the starting dosage of Bisoprolol for treating systolic heart failure?
1.25 mg/day
## Footnote
Target dosage is 10 mg/day.
83
What is the target dosage for Carvedilol in heart failure treatment?
50 mg BID
## Footnote
Starting dosage is <3.125 mg BID.
84
What is the target dosage for Metoprolol succinate in heart failure treatment?
200 mg/day
## Footnote
Starting dosage is 12.5-25 mg/day.
85
Which beta-blocker can be used in asthmatic patients?
Bisoprolol
## Footnote
Carvedilol should not be used in asthmatics.
86
What is the recommendation regarding digoxin use in diastolic heart failure?
Stop digoxin if used in diastolic heart failure.
87
What is the starting dosage of Digoxin for patients over 70 years?
0.125 mg/day or 0.125 mg every other day.
88
What are the symptoms of digoxin toxicity?
Nausea, vomiting, diarrhea, headache, dizziness.
89
What is the normal serum concentration range for digoxin?
0.5 - 0.9 ng/mL.
90
What are some risk factors for digoxin toxicity?
Hypokalemia, hypomagnesemia, hypercalcemia, age, renal dysfunction.
91
What is the antidote for digoxin toxicity?
Digoxin immune FAB (e.g., Digibind, DigiFab).
92
What other agents can be used to treat life-threatening arrhythmias?
Magnesium, phenytoin, lidocaine.
93
True or False: Abrupt discontinuation of beta-blockers can precipitate clinical deterioration.
True.
94
Fill in the blank: The starting dosage of Metoprolol tartrate should be changed to _______ if used in heart failure.
succinate.
95
What should be monitored while a patient is on beta-blockers?
Blood pressure and heart rate.
96
What is the effect of high doses of beta-blockers on mortality compared to ACE inhibitors?
Better effect on mortality than ACE inhibitors.
97
What should be done if dizziness occurs in a patient taking beta-blockers?
Reduce the dose by 50%.
98
What is the effect of beta-blockers on insulin resistance?
May increase insulin resistance and mask hypoglycemia.
99
100
What is the role of Omega-3 fatty acids in HF?
Not recommended for NYHA class II-IV symptoms and HFrEF or HFpEF
## Footnote
Omega-3 fatty acids may have proarrhythmic effects.
101
What is the benefit of an implantable cardioverter defibrillator (ICD)?
Reduces the incidence of sudden cardiac death (SCD)
## Footnote
ICD prevents sudden death from the beginning.
102
What is the purpose of chronic resynchronization therapy (CRT)?
Mortality benefit requires time, while ICD provides immediate protection
## Footnote
CRT is used for patients with QRS ≥ 150 and LVEF ≤ 30%.
103
What is the effect of loop diuretics, thiazides, and Digoxin in systolic heart failure?
No mortality benefit, but improve outcomes and reduce hospitalization and symptoms
## Footnote
ACE inhibitors, ARBs, beta-blockers, and other therapies do improve mortality.
104
What should be monitored in patients with systolic heart failure?
Electrolytes, sodium intake, fluid intake
## Footnote
Monitoring helps manage the condition effectively.
105
What are the effects of hypothyroidism and hyperthyroidism in heart failure?
Hypothyroidism may be masked by HF symptoms; hyperthyroidism worsens systolic dysfunction
## Footnote
Thyroid function should be regularly monitored.
106
What is the recommended exercise approach for patients with heart failure?
Modest exercise program is safe and has modest effects on all-cause hospitalization and mortality
## Footnote
Exercise should be tailored to individual capabilities.
107
Which drugs should be avoided in systolic heart failure ?
* Sympathomimetics: anagrelide, amphetamines
* NSAIDs: ibuprofen, diclofenac, naproxen
* COX-2 inhibitors: celecoxib
* Corticosteroids
* Thiazolidinediones: pioglitazone, rosiglitazone
* Minoxidil
* Pregabalin
*cilostazol
*itraconazole
*metformin
*anthracyclines: doxorubicin, mitoxantrone
## Footnote
These drugs can exacerbate heart failure symptoms.
108
What is the first-line treatment for diastolic heart failure?
B-blocker or a nondihydropyridine CCB (diltiazem or verapamil)
## Footnote
These medications help to slow heart rate and improve ventricular filling.
109
What should be used cautiously in diastolic heart failure?
Diuretics, as patients are fluid-dependent for maximal ventricular filling
## Footnote
Caution is necessary to avoid worsening the patient's condition.
110
What is the role of digoxin in diastolic heart failure?
No role in diastolic HF; stopping digoxin is recommended
## Footnote
Digoxin may increase unstable angina admissions.
111
What should be avoided to prevent reflex tachycardia in diastolic heart failure?
Dihydropyridine CCBs (e.g., nifedipine, amlodipine)
## Footnote
These medications can exacerbate heart failure symptoms.
112
113
114
Describe the symptoms associated with congestion in acute heart failure.
Symptoms include dyspnea, orthopnea, rales (crackles), and edema.
115
Explain the significance of pulmonary capillary wedge pressure (PCWP) in acute heart failure.
PCWP is used to assess congestion; a PCWP greater than 18 mmHg indicates congestion.
116
Define cardiac index (CI) and its normal range.
Cardiac index is a hemodynamic parameter that relates cardiac output to body surface area, with a normal range of 2.5-4 L/min/m2.
117
What does a CI less than 2.2 indicate in acute heart failure?
A CI less than 2.2 indicates hypoperfusion, which can lead to symptoms like cold extremities, fatigue, and altered mental status.
118
Define the grading system for edema severity.
The grading system for edema severity is as follows: 1+ Mild (both ankles/feet), 2+ Moderate (both feet, hands, lower arms, and lower legs), 3+ Severe (bilateral, includes both legs, arms, feet, and face).
119
How should treatment be approached for warm and dry heart failure patients?
For patients who are warm and dry, the treatment approach is to optimize oral medication.
120
What is the treatment for patients who are warm and wet in heart failure?
For patients who are warm and wet, the treatment includes administering furosemide (IV diuretic) and nitroglycerin (venous vasodilator).
121
Explain the treatment for cold and wet heart failure patients.
For cold and wet patients, the treatment includes furosemide (IV diuretic) and one of the following: If MAP < 50, administer IV dopamine. If MAP 50+ with no compelling reason, use a venous or arterial vasodilator. If MAP 50+ with a compelling reason, administer an inotrope.
122
123
What are the main components of maintaining acute decompensated heart failure (ADHF)?
The main components of maintaining ADHF include the use of diuretics, inotropes, and vasodilators, although these treatments do not affect mortality.
124
How should diuretic resistance be managed in heart failure patients?
Describe the risks of using diuretics in cold patients classified as Subset III or IV.
125
Explain the management of B-Blockers and Digoxin in stable patients upon admission.
B-Blockers and Digoxin should not be discontinued in patients who are stable before admission.
126
How should vasodilators be prioritized in treatment, and what is the exception to this rule?
Vasodilators should be prioritized unless there is a compelling reason to use inotropes to improve end organ function, despite the increased mortality risk.
127
128
What is the recommended inotropic agent for patients on B-Blockers, and why?
Milrinone is recommended for patients on B-Blockers because dobutamine is a beta-agonist.
129
Explain the contraindications for using sodium nitroprusside in patients with liver or kidney impairment.
Sodium nitroprusside should never be used in patients with liver or kidney impairment due to the risk of cyanide toxicity.
130
Identify the only vasopressin antagonist indicated for hyponatremia in heart failure.
Tolvaptan is the only vasopressin antagonist indicated for hyponatremia in heart failure.
131
131
133
134
135
