CHF (3/6)

Question 1

systolic vs diastolic HF

Answer 1

systolic LV, reduced EF

diastolic preserved LV EF

Question 2

remodeling

Answer 2

adaptation to reduced CO

cardiac dilation, ^sympathetic tone, water retention and ^BV, natriuretic peptides

Question 3

remodeling neurohormone systems

Answer 3

Renin angiotensin aldosterone, sympathetic nervous

Question 4

CHF s/s

Answer 4

s3 gallop, cool pale cyanotic extremities, crackles, vBreath sounds (effusion), ^jugular venous pressure, LE edema, ascites, hepatomegaly, splenomegaly, displaced PMI

Question 5

CHF diagnostics

Answer 5

echo (syst vs dias, valve disease), xray (cephalization pulm vessels, Kerley B lines), EKG (ischemic heart disease)

Question 6

BNP level of exacerbation

Answer 6

100+

Question 7

CHF tx

diuretics

Answer 7

(mod) Thiazide = vK( ^dig toxicity), w minimal edema
(large) Loop diuretics=vK(^dig toxicity), hypotension, work when gfr is low, for severe HF
(scant) K sparing diuretics-counteract K loss by other meds (vRisk for Dig tox), risk ^K*caution w ARBs/ACEi (dc diuretic)

Question 8

which diuretic prolongs survival, why

Answer 8

spironolaction bc blocks aldosterone receptors (not bc diuresis)

Question 9

ACEi AE

Answer 9

vBP, ^K, cough, angioedema, renal failure (bilateral renal artery stenosis) fetal injury

Question 10

ARB

Answer 10

^LV EF, vHF sx, ^exercise tolerance, vHospitalization, vMortality

Question 11

ARNI

angiotensin receptor blocker + neprolysin inhibitor

Answer 11

entresto
^natiuretic peptides, vAE of RAAS
used in place w ace/arb NOT w/

Question 12

DRI

direct renin inhibitor

Answer 12

HTN only, not HF

Question 13

B Blockers

1st line

Answer 13

protect from sympathetic stimulation and dysrhythmias
^LV EF, ^survival
AE: fluid retention, worse HF, fatigue, hypotension, vHR, heart block

Question 14

Ivabradine

Answer 14

for stable chronic HF
EF <35%
NSR
70bpm on highest b blocker w/o improvement

Question 15

Vericiguat

Answer 15

after hospitalization/outpt diuresis for HF <45%,

AE: vBP, xPD5i, xPregnant

Question 16

SGLT-2i

Empaglifozin, Dapaglifozin

Answer 16

<40%, vMortality, improve sx,

Question 17

Isosorbide+hydralazine effective for

Answer 17

AA

Question 18

Digoxin and cardiac glycosides

Answer 18

inotropic (^contraction, alter electrical activity, favorable affect neurohormonal systems
2nd line, does not improve mortality, only sx
compete w K for binding

Question 19

Digoxin hemodynamic benefits

Answer 19

vSympathetic tone, ^Urine, vRenin release

vHR, ^cardiac filling, vAfterload, vVenous pressure

Question 20

Digoxin neurohormonal benefits
effect on vagus nerve
effect on kidney

Answer 20

supresses renin release=vNa sodium absorption, decreases sympathetic outflow=^`sensitivity cardiac baroreceptors= signal nervous system to reduce sympathetic traffic to periphery

Question 21

ACEi

essential HF therapy**

Answer 21

block angiotensin2, vAldosterone, =benefit to cardiac remodeling (due to ^kinins)
arteriole dilation=^blood to kidney, vAftedrload, ^strokevolume/CO
=NA/ water excreted, venous dilation=vVenous pressure, pulmonary congestion, pulm edema, preload, cardiac dilation
aldosterone release suppresion=^sodium water release, ^K retention

Question 22

CHF stage A

Answer 22

risk factors present

Question 23

CHF stage B

Answer 23

structural heart disease-LV fibrosis, hypertrophy, LV dilation, hypocontractility, valv heart disease, previous MI
***try to prevent sx from appearing

Question 24

CHF stage C

Answer 24

sx and structural heart disease
tx:diuretics, ACEi/ARB. B blocker, aldosterone antagonist for patients with severe sx after MI but monitor K/renal function
digoxin
isosorbide-hydralazine (AA)

Question 25

CHF stage C drugs to avoid

Answer 25

antidysrhythmic agents, ca channel blockers, NSAIDs, aspirin

Question 26

CHF stage D

Answer 26

b blockers can make HF worse, ACEi=hypotension/renal failure

heart transplant/palliative

Question 27

ICD

biventricular pacemaker

Answer 27

EF<35%

helps ventricles pump together correctly (good for ascynchronus HF)

Question 28

Refractory HF

Answer 28

inotropic drugs (dobutamine, dopamine, milrinone, nitro)