CVS - Diseases of the Myocardium, Heart Failure and Treatment Flashcards
What is heart failure?
Heart failure is a condition where the heart cannot pump enough blood to meet the body’s needs.
What are the types of heart failure?
Systolic and diastolic dysfunction.
How do beta-blockers work in heart failure?
They reduce heart rate and myocardial contractility, decreasing oxygen demand.
Name a non-selective beta-blocker.
Propranolol.
What is a cardioselective beta-blocker?
A beta-blocker that predominantly blocks beta-1 receptors, like metoprolol.
What is Sacubitril-Valsartan used for?
It’s used for reducing the risk of cardiovascular death and hospitalization in heart failure patients.
What is the action of loop diuretics in heart failure?
They reduce fluid overload by inhibiting sodium reabsorption in the kidneys.
Name a loop diuretic used in heart failure.
Furosemide.
What are potassium-sparing diuretics’ role in heart failure?
They help conserve potassium while eliminating sodium and water.
What is the mechanism of action of hydralazine in heart failure?
It’s a vasodilator that decreases afterload.
What is Isosorbide Mononitrate/Dinitrate’s role in heart failure?
They are vasodilators that reduce preload and afterload.
How do cardiac glycosides like Digoxin work in heart failure?
They increase the force of myocardial contraction.
What are the adverse effects of beta-blockers in heart failure?
Bradycardia, hypotension, and fatigue.
What is the key adverse effect of Sacubitril-Valsartan?
Angioedema.
What electrolyte imbalance can loop diuretics cause?
Hypokalemia.
What is an example of a potassium-sparing diuretic?
Spironolactone.
What is a major side effect of hydralazine?
Reflex tachycardia.
What is a contraindication for Isosorbide Mononitrate/Dinitrate?
Concurrent use with phosphodiesterase inhibitors.
What is a risk with cardiac glycosides like Digoxin?
Narrow therapeutic window and toxicity.
What is the pharmacokinetics of beta-blockers in heart failure?
Variable absorption and metabolism, some cross the blood-brain barrier.
How is Sacubitril-Valsartan administered?
Orally.
What is the primary site of action for loop diuretics?
The ascending limb of the loop of Henle in the kidneys.
How are potassium-sparing diuretics metabolized?
In the liver.
What is hydralazine’s pharmacokinetics in heart failure?
Rapidly absorbed orally and metabolized in the liver.
How does Isosorbide Mononitrate/Dinitrate improve heart failure symptoms?
By reducing myocardial oxygen demand.
What is the therapeutic use of Digoxin in heart failure?
To improve symptoms and increase exercise capacity.
What monitoring is necessary for beta-blocker therapy in heart failure?
Heart rate and blood pressure monitoring.
What is a unique feature of Sacubitril in Sacubitril-Valsartan?
It’s a neprilysin inhibitor, enhancing natriuretic peptides.
What precaution is needed when prescribing loop diuretics?
Monitoring electrolytes, especially potassium.
In which patients are potassium-sparing diuretics especially beneficial?
Patients at risk of hypokalemia.
What is a common indication for hydralazine in heart failure?
In combination therapy for symptomatic heart failure.
What is the dose adjustment criterion for Isosorbide Mononitrate/Dinitrate in heart failure?
Based on patient response and tolerance.
How is Digoxin toxicity managed?
With Digoxin immune Fab and supportive care.
What are the drug interactions of beta-blockers in heart failure?
Interaction with anti-arrhythmic drugs and insulin.
What is an important drug interaction for Sacubitril-Valsartan?
With ACE inhibitors and ARBs.
Name a side effect specific to potassium-sparing diuretics.
Hyperkalemia.
What is a unique adverse effect of hydralazine?
Lupus-like syndrome.
How does Isosorbide Mononitrate/Dinitrate affect blood pressure?
They can cause hypotension.
What is the effect of Digoxin on heart rate?
It can decrease the heart rate.
How do beta-blockers affect exercise capacity in heart failure?
They may initially decrease exercise capacity.
What is the effect of Sacubitril-Valsartan on renal function?
It can worsen or improve renal function.
How do loop diuretics affect renal function?
They can cause renal impairment with excessive use.
What is a rare but serious side effect of potassium-sparing diuretics?
Gynecomastia with spironolactone.
What is the interaction of hydralazine with other heart failure medications?
It can potentiate the effect of other antihypertensives.
What dietary advice is necessary for patients on Isosorbide Mononitrate/Dinitrate?
Avoid alcohol as it can enhance the hypotensive effect.
What are the treatment goals for heart failure with preserved ejection fraction (HFpEF)?
Treatment aims to manage symptoms and comorbidities like hypertension and renal dysfunction.
How do ARNIs benefit patients with HFpEF?
ARNIs may reduce hospitalizations for heart failure in HFpEF patients.
What is the role of SGLT2 inhibitors in HFpEF treatment?
SGLT2 inhibitors like empagliflozin can reduce mortality and hospitalizations in HFpEF.
What is the role of beta-blockers in HFpEF?
Beta-blockers are used only when there is an existing indication like atrial fibrillation, angina, or post-myocardial infarction.
Why are aldosterone antagonists used in heart failure?
They reduce mortality and are particularly useful in patients with left ventricular ejection fraction (LVEF) < 30% and chronic heart failure.
What monitoring is required when using aldosterone antagonists?
Regular monitoring of serum potassium and creatinine levels is necessary.
What is the preferred combination therapy in patients with HFrEF?
An aldosterone antagonist plus either an ACE inhibitor or an ARB.
How do ACE inhibitors benefit heart failure patients?
They improve hemodynamics by causing arterial and venous vasodilation and have favorable effects on ventricular remodeling.
Why might digoxin be harmful in patients with certain types of cardiomyopathy?
In infiltrative, restrictive, or hypertrophic cardiomyopathy, digoxin is not effective and may be harmful.
What is the benefit of ARNIs in heart failure with mildly reduced ejection fraction (HFmrEF)?
ARNIs may specifically benefit patients with HFmrEF, although this requires further confirmation.
What is the role of SGLT2 inhibitors in HFmrEF?
SGLT2 inhibitors like empagliflozin benefit patients with HFmrEF as part of standard care.
What should be avoided when using aldosterone antagonists?
Concurrent use with both an ACE inhibitor and an ARB due to the high risk of hyperkalemia and renal dysfunction.
What is the therapeutic action of ARNIs in heart failure?
ARNIs combine a neprilysin inhibitor with an ARB to enhance natriuretic peptides and improve artery opening and blood flow.
What are the considerations for using beta-blockers in heart failure?
Beta-blockers should be used carefully as they may exacerbate symptoms in severe HFpEF by lowering cardiac output.
When are aldosterone antagonists particularly indicated in HFpEF?
In patients with HFpEF who are volume overloaded and/or have a history of HF hospitalization.
