. Clinical and pharmacological approaches in the treatment of chronic heart failure

Question 1

chronic heart failure defiinition

Answer 1

syndrome, due to systolic and/or diastolic dysfunction of the cardiac muscle, leading to dyspnea and fatigue as a result of reduced CO

Question 2

types of

Answer 2

According to the output:
-low output/ high output

According to the affected side
-LHF/RHF

According to the clinical course
- acute/ chronic

Question 3

which type of output is most common

Answer 3

Low-output heart failure - 95%

can be systolic or diastolic

Question 4

describe systolic low output HF

Answer 4

heart muscle loses its ability to contract (systolic dysfunction).

Characterised by;
-decreased cardiac output

-decreased left ventricular ejection fraction (LVEF)

Question 5

describe diastolic low output HF

Answer 5

heart muscle becomes stiff and doesn’t fill with blood easily (diastolic dysfunction)

characterised by:

• elevated left and right ventricular end-diastolic pressures (heart muscle wont relax)
• normal LVEF

Question 6

conditions causing High-Output Heart Failure

Answer 6

peripheral shunting (A-V fistula), - heart pumps more but blood is still lost

low-systemic vascular resistance,

hyperthyroidism,

anemia,

pregnancy, etc

Question 7

what is Left-sided heart failure

Answer 7

inefficient contraction of the left ventricle to supply oxygenated blood to body

• chronic hypertension
• valve defects

Question 8

what is Right-sided heart failure

Answer 8

failure of the right ventricle:

2nd to LHF / pulm diseases

Question 9

Acute HF

Answer 9

Dramatic drop in cardiac output

short course of hours to days

causes

• sepsis
• acute mi

Question 10

Chronic HF

Answer 10

long term processes assoc w/ comp changes of the heart that no longer produce sufficient EF

Question 11

new york heart assoc of heart failure

Answer 11

Class 0- no complaints
Class 1- without symptoms in heavy exercise
Class 2- decreased physical capacity and complaints of fatigue with usual physical exercises
Class 3- significantly decreased physical capacity and complaints of fatigue and dyspnea with low intensity physical efforts
Class 4- complaints at rest

Question 12

CHF Stages-according to the structural changes of the heart

Answer 12

Stage A- no structural or functional changes in the heart, no symptoms, but the patient is at high risk of developing HF

Stage B- minimal structural or functional changes in the heart, but no symptoms

Stage C
C1- changes in the heart, plus present symptoms of CCF
C2- advanced changes in the heart, plus present symptoms of CCF

Stage D- patient with advanced cardiac disease and marked symptoms of CCF at rest, who’s given the maximal therapy needed, but remains uncompensated.

Question 13

Pathophysiological mechanisms of compensation in HF

4

Answer 13

Neurohormonal activation

RAAS activation

Frank-Starling mechanism

Ventricular remodeling-

Question 14

Neurohormonal activation in CHF (sympathetic)

Answer 14

Increases ventricular contractility and heart rate

Systemic and pulmonary vasoconstriction

Stimulates secretion of renin from juxtaglomerular apparatus of the kidney

Question 15

effect of angiotensin in CHF

Answer 15

• V.C
  norepinephrine (symp activity)
  -synthesis and secretion of aldosterone which leads to: sodium and water retention

Question 16

Frank-Starling mechanism

Answer 16

he strength of the heart’s systolic contraction is directly proportional to its diastolic expansion

Question 17

effect of Ventricular remodeling in CHF

Answer 17

change of heart shape structure and function to increase CO

Question 18

Classification of drugs for the treatment of CCF-

Answer 18

drugs alleiviating symptoms

drugs reducing morbidity

Question 19

Drugs affecting the mortality/morbidity ratio

Answer 19

ACE inhibitors
Angiotensin receptor blockers
β- blockers
Aldosterone antagonists

Question 20

drugs alleiviating symptoms

Answer 20

diuretic - odema is major symp

Cardiac glycosides

dobutamine

Question 21

drugs prescribied in NYHA Class 1

Answer 21

mortality drugs

ACEI
ARB- if ace is CI
Beta blockers after MI

symp
NONE

Question 22

drugs prescribied in NYHA Class 2

Answer 22

mortality drugs
ACEI
ARB- if ace is CI
Beta blockers after MI

symp
diuretic according oedema presence

Question 23

drugs prescribied in NYHA Class 3

Answer 23

mortality mod
ACEi/ ARB combined w.
beta blocker / aldosterone antag

symp
-cardiac glycoside or diuretic

Question 24

drugs prescribied in NYHA Class 4

Answer 24

mortality mod
ACEi/ ARB combined w.
beta blocker / aldosterone antag

symp

• CG
• Diuretic
• inotropic drugs
• dobutamine

Question 25

rx in assymp LV dysfunc

EF BELOW 40% e/o symp

Answer 25

ACEi
ARB
B blocker in presence of MI

Question 26

rx im CHF w/ preserved LV func d/2
-arrythmia
-KF
(reduce load on heart)

Answer 26

diuretics
β-blockers,
ACE inhibitors
ARBs.

Question 27

drugs used in CHF w/ angina

Answer 27

b blockers w/ vasodilating effect
(carvedilol) (nevibilol)

nitrates

Question 28

drugs used in CHF w/ supravent arryhth

Answer 28

beta blockers d/2 anti arrythmic effect

cardiac glycoside d/2 anti arrythmic effect

Question 29

drugs used in CHF w/ kidney failure

Answer 29

beta blockers

furosemide ( k saving are CI)

dose corrected CG d/2 renal excretion

CI acei cause that furthers insufficiency

Question 30

drugs used in CHF w/ COPD

Answer 30

ACEi

beta blockers ci d/2 broncho conriction

Question 31

ACE inhibitors examples

Answer 31

Enapril 2x 20mg MD
Captopril 3x 50 mg MD
Lisinopril 1x40 mg MD

Question 32

Angiotensin receptor blockers

Answer 32

Valsartan 2x 160 mg MD

Telmisartan 2X 80mg MD

Question 33

β- blockers

Answer 33

Carvedilol 2x 25mg MD
Nebivolol 1x 10 mg MD
metoprolol 1x 200mg MD
bisoprolol

Question 34

Diuretics

Answer 34

furosemide up to 400mg /day

Question 35

Cardiac glycosides-

Answer 35

digoxin 1x 0.25mg MD
methyldigoxin,
digitoxin

Question 36

(aldosterone antagonists)-

Answer 36

spironolactone 1x 50 mg MD

eplerenon 1x 50 mg MD