Congestive Heart Failure

Question 1

In CHF the intravascular volume is _______, leading to _______ preload this leads to increased edema

Answer 1

increased; increased

ventricle is working harder to get blood out

Question 2

Drug classes that reduce preload (5)

Answer 2

diuretics, nitrates, ACE-I, ARB, ARNI

reduces after load so heart can pump better

Question 3

In CHF the arteries constrict to maintain blood pressure in the face of reduced cardiac output (afterload) overtime this lead to the heart to “______”

Answer 3

wear out

Question 4

Drugs that reduce after load include (4)

Answer 4

ACE-I, ARB, ARNI, “direct” vasodilators (like hydralazine)

Question 5

Kidney is hypoperused so it releases ___(1)____

___(1)____ breaks down angiotensin pre cursor to angiotensin I

The ACE-I inhibits Ace which acts from the angiotensin I converting to ____(2)_____

____(2)____ goes to become (if not inhibited) AT1 receptor which can be inhibited by ____(3)_____

AT1 receptors lead to outcome of either ____(4)____ or stimulating release of aldosterone from adrenal cortex

Aldosterone from adrenal cortex leads to the outcome of ___(5)____ retention and ___(6)____ excretion

Answer 5

1. renin
2. Angiotensin II
3. ARB
4. Vasoconstriction
5. Na+ retention
6. K+ excretion

Question 6

Commonly used ACE-I drugs

Answer 6

“-prils”

captopril, enalapril, fosinopril

Question 7

Commonly used ARB’s (angiotensin receptor blockers)

Answer 7

“-startan”

lostartan, valsartan, telmistartan, candesartan

Question 8

ACE-I side effects

(angiotensin converting enzyme)

Answer 8

hypotension
cough (bradykinin)
angioedema (swelling of lips, tongue, face)
hyperkalcemia
dyspepsia ( loss of or metallic taste —> captopril)

Question 9

Angiotensin Receptor blockers (ARB’s) are alternatives for ______ if patient has ACE-I cough

Answer 9

ACE-I

Question 10

Formly considered first line therapy for CHF along with ACE-I , but now _______/_________ is first line

Answer 10

sacubitril/ valsartan

Question 11

You give ____ to someone who cant take sacubitril because of blood pressure problems since it drops blood pressure

Answer 11

ARB’s “sartans”

Question 12

ARB’s side effects

Answer 12

Dysguesia (metallic taste, burning tongue, loss of taste)

Angioedema (face and lip swelling, sore throat)

Cough (occurs in 1 in 4 patients with ACE-I cough)

Question 13

Activation of the sympathetic nervous system in CHF has a _________ compensatory response

Early response: 3
Chronic late response : 5
Outcome :1

Answer 13

Maladaptive

Early response : increased heart rate , contractility, vasoconstriction
Chronic late response: increased oxygen demand, ischemia, oxidative stress, cardiac fibrosis and necrosis , decreased B-receptor density (reduce adrenergic response)
Outcome: progressive worsening of heart failure

Question 14

What’s is the reversible drug of CHF?

Answer 14

B-blocker

Restores the existing catecholamines to start working

Question 15

What drugs improves survival and reduces hospitalization in heart failure patients?

Answer 15

B-blockers