Drugs for heart failure

Question 1

Explain what is meant by heart failure

Answer 1

Clinical syndrome associated with symptoms due to abnormalities in
cardiac structure and/or function substantiated by the presence of
increased natriuretic peptide plasma concentrations or objective
evidence of pulmonary or systemic congestion of cardiogenic origin

Question 2

List 4 heart failure classes

Answer 2

HF with reduced EF (HFrEF)
HF with mildly reduced EF (HFmrEF)
HF with preserved EF (HFpEF)
HF with improved EF (HFimpEF)

Question 3

What is the left ventricular ejection faction for HF with improved EF (HFimpEF)

Answer 3

HF with baseline LVEF ≤40% (0.4), a ≥10
point increase from baseline LVEF, and a
second measurement of LVEF >40% (0.4)

Question 4

What is the left ventricular ejection faction for HF with preserved EF (HFpEF)

Answer 4

HF with LVEF ≥50% (0.5)

Question 5

What is the left ventricular ejection faction for HF with reduced EF (HFrEF)

Answer 5

HF with LVEF ≤40% (0.4)

Question 6

What is the left ventricular ejection faction for HF with mildly reduced EF (HFmrEF)

Answer 6

HF with LVEF 41%49% (0.41-0.49)

Question 7

Systolic dysfunction results to what?

Answer 7

Systolic dysfunction results in a decline in cardiac output leading to the
activation of a number of neurohormonal compensatory responses that
attempt to maintain adequate cardiac output,

Question 8

Systolic dysfunction maintain Cardiac output by activation of what?

Answer 8

Sympathetic nervous system (SNS)
* Renin-angiotensin-aldosterone system (RAAS)
* other systems
* Cardiac dilatation
* Ventricular wall thinning
* Interstital fibrosis
* Wall stiffness

Question 9

The compensating mechanisms for heart failure HFrEF plays an important role where?

Answer 9

These compensatory mechanisms play an important role in ventricular
remodelling and contribute to the progression of HF.

Question 10

Pharmacotherapy targeted at antagonizing this neurohormonal activation slows what?

Answer 10

Pharmacotherapy targeted at antagonizing this neurohormonal activation
slows the progression of HFrEF and improves survival.

Question 11

Symptoms for HF

Answer 11

The symptoms of heart failure are
produced by reduced tissue
perfusion, oedema and increased
central venous pressure.

Question 12

List the Primary manifestations of both HFrEF and HFpEF:

Answer 12

• Dyspnea and fatigue, which lead to exercise intolerance, and
• Fluid overload, which can result in peripheral edema and pulmonary
  congestion

Question 13

NYHA functional classes
List all 4 classes and explain them

Answer 13

CLASS I
Patients with cardiac disease but without limitations of physical activity.
Ordinary physical activity does not cause undue fatigue, dyspnea, or
palpitation.
Class II
Patients with cardiac disease that results in slight limitations of physical
activity. Ordinary physical activity results in fatigue, palpitation, dyspnea, or
angina.
Class III
Patients with cardiac disease that results in marked limitation of physical
activity. Although patients are comfortable at rest, less than ordinary activity
will lead to symptoms.
Class IV
Patients with cardiac disease that results in an inability to carry on physical
activity without discomfort. Symptoms of congestive HF are present even at
rest. With any physical activity, increased discomfort is experienced.

Question 14

List the 5 CCF goals for therapy

Answer 14

• Improve the patient’s quality of life,
• Relieve or reduce symptoms,
• Prevent or minimize hospitalizations,
• Slow progression of the disease, and
• Prolong survival.

Question 15

First step in the management of chronic HF is to determine
List the 5 points

Answer 15

First step in the management of chronic HF is to determine:
* Classification of HF based upon LVEF and
* Symptoms based upon NYHA functional class and/or any precipitating
factors.
* Appropriate treatment of underlying disorders (eg, hyperthyroidism,
valvular heart disease) may obviate the need for specific HF treatment.
* Revascularization or anti-ischemic therapy in patients with coronary
disease may reduce HF symptoms.
* Drugs that aggravate HF should be discontinued if possible.

Question 16

restriction of dietary sodium and fluid intake important for which lifestyle intervation

Answer 16

Restriction of dietary sodium and fluid intake is an important lifestyle
intervention for both HFrEF and HFpEF.

Question 17

Mild (<3 g/day) to moderate (<2 g/day) sodium restriction, in conjunction
with daily measurement of weight, should be implemented to minimize what?

Answer 17

Mild (<3 g/day) to moderate (<2 g/day) sodium restriction, in conjunction
with daily measurement of weight, should be implemented to minimize
volume retention and allow the use of lower and safer diuretic doses.

Question 18

Patients should avoid what when minimizing dietary sodium and fluid intake

Answer 18

Patients should avoid adding salt to prepared foods and eliminate foods high
in sodium (eg, saltcured meats, salted snack foods, pickles, soups,
delicatessen meats, and processed foods).

Question 19

In patients with hyponatremia (serum Na <130 mEq/L [mmol/L]) or those with persistent volume retention despite high diuretic doses and sodium restriction, daily fluid intake should be

Answer 19

In patients with hyponatremia (serum Na <130 mEq/L [mmol/L]) or those
with persistent volume retention despite high diuretic doses and sodium
restriction, daily fluid intake should be limited to 2 L/day from all sources.
However, both sodium and fluid restriction must be done with care in
patients with HFpEF.

Question 20

HFrEF should be routine treated with following of what?

Answer 20

HFrEF should be routinely treated with guidelines -directed medical
therapy (GDMT)—medications known to reduce mortality in these patients

Question 21

Name 4 medication classes for HFrEF treatment

Answer 21

• an ARB/neprilysin inhibitor (ARNI) or ACEI or ARB,
• an evidence-based β-blocker,
• an aldosterone antagonist, and a
• Sodium-glucose cotransporter2 (SGLT2) inhibitor.

Question 22

GDMT dosing should be done what?

Answer 22

GDMT dosing should be titrated to achieve target doses known to be effective in randomized clinical trials