CV 21

Question 1

what are the most common causes of HF

Answer 1

ischemic cardiomyopathy
- infarct (previous MI)
- ischemia (CCD)
non ischemic cardiomypathy
- HTN
- Dilated cardiomyopathy (alcohol, cocaine, genetic)
- valvular heart disease
- medications (chemotherapy)

Question 2

cardinal signs and symptoms of HF

Answer 2

breathlessness, fatigue, peripheral edema

Question 3

Stage A - at risk

Answer 3

at risk for HF without S/s of HF
- HTN, CVD, DM, fam history of cardiomyopathy

Question 4

Stage B - Pre-HF

Answer 4

without current s/s but evidence of 1 of the following:
1. Structural Heart Disease
2. Abnormal Cardiac Function
3. Elevated natriuretic peptide levels or cardiac troponin in the setting cardiotoxins

Question 5

Stage C - heart failure

Answer 5

with current S/S of HF,

Question 6

Stage D - Advanced

Answer 6

Severe s/s of HF at rest, recurrent hospitalizations despite GDMT

Question 7

What is the ejection fraction

Answer 7

amount of blood pumped out/amount of blood in chamber

Question 8

HFrEF

Answer 8

HF with reduced ejection fraction (<= 40%)

Question 9

HFmrEF

Answer 9

HF with mildly reduced EF (41-49%)

Question 10

HFpEF

Answer 10

HF with preserved ejection fraction (EF >= 50%)

Question 11

standard therapies HFrEF (MABS)

Answer 11

ARNI, ACEI, ARB
Beta-blocker
MRA
SGLT2i

Question 12

ARNI compred to ACEI

Answer 12

more effective, but increased hypotension

Question 13

two proven beta blockers reducing death in HFrEF

Answer 13

bisoprolol
Carvedilol

Question 14

when are beta blockers contraindicated

Answer 14

low heart rate <60bpm

Question 15

Contraindications of an MRA

Answer 15

eGFR <30
K>2.2mmol/L

Question 16

common SE with MRA, specifically spironolactone

Answer 16

Gynecomastia
HYPERKALEMIA

Question 17

do flozins work the same in pts with or without DM

Answer 17

yes

Question 18

Flozins CI

Answer 18

Type 1 DM, on dialysis

Question 19

do you need to titrate flozins

Answer 19

no! 10mg daily

Question 20

Flozin SE

Answer 20

Yeast infections!

Question 21

what do flozins do in terms of GFR

Answer 21

lower it, it is expected and not concerning

Question 22

which drug causes the side effect sexual dysfunction

Answer 22

beta blockers

Question 23

do a fluid assessment with which med

Answer 23

beta blockers, SGLT2i

Question 24

Digoxin

Answer 24

decreases hospitalizations. Only used after all GDMT

Question 25

Hydralazine indication + SE

Answer 25

Pts with HFrEF who are unable to toelrate an ACEARBARNI because of hyperkalemia, renal dysfunction or other CI.

Pts who are black after GDMT

Interacts with Phosphodiesterase 5 inhibitors

Question 26

Ivabradine

Answer 26

HFrEF pts with GDMT max, resting HR of >70bpm

Question 27

how long should a patient be on these therapies

Answer 27

generally. lifelong.

Question 28

which medication reduce hospitalizations in HFpEF

Answer 28

SGLT2i (flozins)

Question 29

which medication reduce hospitalizations in HFmrEF

Answer 29

flozins and MRA

Question 30

do any of these medications prolong survival in HFpEF or HFmrEF

Answer 30

NO!!