Chronic Heart Failure

Question 1

When does heart failure occur?

Answer 1

when the heart is unable to supply the body sufficient oxygen-rich blood due to inability to fill or eject blood via the ventricle

Question 2

Difference between ischemic and non-ischemic heart failure

Answer 2

ischemic: due to decreased blood supply (post-MI)

non-ischemic: due to long-standing uncontrolled blood pressure

Question 3

What does an EF <40% represent?

Answer 3

systolic dysfunction (contraction) or reduced ejection fraction

Question 4

When is it HFpEF

Answer 4

EF >/= 50% Car

Question 5

At which ACC and NYHA staging/classification is a patient experiencing symptoms of HF and some structural heart disease

Answer 5

ACC: C
NYHA: II

Question 6

What lab elevation can indication systolic heart failure

Answer 6

elevated BNP (>100)

Question 7

Equation for cardiac output

Answer 7

CO = HR x SV

Question 8

Equation for CI

Answer 8

CI = CO / BSA

Question 9

How does the body compensate for a HFrEF or low cardiac output state?

Answer 9

activates neurohormonal pathways to increase blood volume and increase force/speed of contractions
temporarily increases CO but leads to cardiac remodeling

Question 10

Why is RAAS activated in HF

Answer 10

the natriuretic peptides that balance the system are insufficent

Question 11

Describe RAAS/Vasopressin activation

Answer 11

Renin converts angiotensinogen to Ang I
Ang I converted to Ang II by ACE
Ang II causes vasoconstriction and aldosterone and vasopressin release from the adrenal and pituitary gland respectively
Aldosterone prompts sodium and water retenion
Vasopressin causes vasoconstriction and water retention

Question 12

What drugs can worsen HF symptoms?

Answer 12

DI NATION 
DDP4 inhibitors (gliptin) 
Immunosuppressants 
Non-DHP CCBs 
Antiarrhythmics 
Thiazolidinediones (glitazone) 
Itraconazole 
Oncology drugs 
NSAIDS

Question 13

Treatment combo in HF

Answer 13

ACEi or ARB (entresto)+ Beta block + Loop

aldosterone antagonists are added next

Question 14

How does a BB work in HF

Answer 14

it interferes with SNS activation by preventing increased HR and contractility (inotropic effects)

Question 15

How does ACEi/ARBS work in HF

Answer 15

Prevent RAAS activation and thus fluid retention and vasoconstriction (stop the increased pre and afterload)

Question 16

How do loops work in HF

Answer 16

prevents fluid retention

Question 17

How does sacubitril work in HF

Answer 17

upregulates natriuetic peptides to balance out the overactivation of the SNS and RAAS

Question 18

How does digoxin work in HF

Answer 18

provides an increase in CO to prevent overcompensation and thus improves symptoms and reduces hospitalizations

Question 19

which HF drugs have mortality benefits?

Answer 19

ACEi, ARBs, Entresto, beta blockers

Question 20

which HF drugs do not have a mortality benefit

Answer 20

loops, digoxin (symptom management)

Question 21

Allergy warning in loop diuretics

Answer 21

sulfa!

Question 22

Loop equivalent dosing

Answer 22

Furosemide 40mg = torsemide 20mg = bumetidine 1 mg = ethacrynic acid 50mg

Question 23

Furosemide IV:PO

Answer 23

1:2

Question 24

What can be added on if patient has insufficent response to a loop?

Answer 24

thiazide like metolazone!

Question 25

Which beta blockers can be used in HF

Answer 25

one’s without ISA
metoprolol succinate
carvedilol
bisoprolol

Question 26

CI for digoxin

Answer 26

ventricular fibraliation

Question 27

Which potassium dosage form should not be cut in half

Answer 27

K-Tab, Klor-Con

* but Klor-Con M can!