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Drugs > Elm 14 Heart Failure > Flashcards

Elm 14 Heart Failure Flashcards

1
Q

Q: What is another term for heart failure?

A

A: Congestive heart failure.

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2
Q

Q: What is the primary inability in heart failure?

A

A: The inability of the heart to meet the oxygen demands of the rest of the body.

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3
Q

Q: Name three possible causes of heart failure.

A

A: Hypertension, genetic factors, and coronary artery disease/myocardial infarction.

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4
Q

Q: What does the Frank-Starling curve relate to?

A

A: The Frank-Starling curve relates end diastolic pressure to stroke volume.

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5
Q

Q: What is end diastolic pressure?

A

A: The degree of stretch of cardiac muscle fibers at the end of diastole.

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6
Q

Q: How is stroke volume related to exercise in individuals with heart failure?

A

A: People with heart failure have poor tolerability for exercise due to high end diastolic pressure resulting in a high stroke volume.

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7
Q

Q: List four symptoms of heart failure.

A

A: Cough, tiredness, shortness of breath, and pulmonary edema.

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8
Q

Q: What happens to the pumping action of the heart in heart failure?

A

A: The pumping action of the heart gets weaker.

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9
Q

Q: What percentage of people in Europe and North America are affected by heart failure?

A

A: 1.3-4%.

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10
Q

Q: How many people in the UK are estimated to have heart failure?

A

A: Up to 900,000 people.

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11
Q

Q: What is the 5-year survival rate for heart failure?

A

A: 50%.

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12
Q

Q: What are the two key problems in heart failure?

A

A: The heart doesn’t contract well, or the heart doesn’t fill well.

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13
Q

Q: What are the two classifications of heart failure?

A

A: Systolic and diastolic failure; reduced ejection fraction and preserved ejection fraction.

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14
Q

Q: How is ejection fraction calculated?

A

A: Ejection fraction = 100(stroke volume)/ventricle volume (%).

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15
Q

Q: What is the normal ejection fraction for a healthy heart?

A

A: 60%.

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16
Q

Q: What is considered a reduced ejection fraction?

A

A: Less than 40%.

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17
Q

Q: Name three risk factors for heart failure with reduced ejection fraction.

A

A: Previous myocardial infarction, diabetes, and valve disease.

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18
Q

Q: What is considered a preserved ejection fraction?

A

A: Greater than 50%.

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19
Q

Q: Name two risk factors for heart failure with preserved ejection fraction.

A

A: Hypertension and atrial fibrillation.

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20
Q

Q: What is dilated cardiomyopathy (DCM)?

A

A: A condition where the ventricle is enlarged and baggy, leading to heart failure with reserved ejection fraction.

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21
Q

Q: What percentage of dilated cardiomyopathy cases are familial?

A

A: About 50%.

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22
Q

Q: What is hypertrophic cardiomyopathy (HCM)?

A

A: A condition where the ventricle has a thick muscle wall, leading to filling problems.

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23
Q

Q: How is hypertrophic cardiomyopathy typically inherited?

A

A: It is mostly inherited in an autosomal dominant pattern.

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24
Q

Q: Name two sarcomere proteins where mutations are known to cause cardiomyopathies.

A

A: Actin and myosin, MLCK, titin

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25
Q

Q: What are the three types of heart failure based on the affected side of the heart?

A

A: Left-sided heart failure, right-sided heart failure, and biventricular heart failure.

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26
Q

Q: Why is pitting edema not diagnostic for heart failure?

A

A: Because it can arise from other conditions as well.

27
Q

Q: How can someone with heart failure compensate initially for decreased cardiac output?

A

A: Through activation of the sympathetic nervous system (SNS) and renin-angiotensin-aldosterone system (RAAS), leading to vasoconstriction, tachycardia, and increased salt and water retention.

28
Q

Q: Why is the initial compensation for heart failure considered maladaptive in the long term?

A

A: Because it leads to further damage to the heart.

29
Q

Q: What can result from decompensation in heart failure?

A

A: Acute worsening of symptoms and potential arrhythmias due to muscle remodeling.

30
Q

Q: Can heart failure be cured?

A

A: No, heart failure cannot be cured.

31
Q

Q: What did the CONSENSUS and SOLVD trials show about ACE inhibitors?

A

A: They improve survival and slow the progression of heart failure.

32
Q

Q: Which trial indicated that bisoprolol improves survival in heart failure patients?

A

A: The CIBIS-2 (Cardiac Insufficiency Bisoprolol Study 2) trial.

33
Q

Q: According to the COMET trial, which beta-blocker is superior: carvedilol or metoprolol?

A

A: Carvedilol is superior to metoprolol.

34
Q

Q: What were the findings of the RALES trial regarding spironolactone?

A

A: Spironolactone improves survival and slows the progression of heart failure compared to placebo.

35
Q

Q: What did the CHARM trial demonstrate about ARBs?

A

A: ARBs share the benefits of ACE inhibitors, but combining ARB with ACE inhibitor provides no additional benefit.

36
Q

Q: What was the result of the PARADIGM-HF trial?

A

A: The combination of valsartan and sacubitril was superior to enalapril and the trial was terminated early due to its benefits.

37
Q

Q: What did the SHIFT trial demonstrate about ivabradine?

A

A: Ivabradine reduced deaths and hospitalizations compared to placebo.

38
Q

Q: What was the outcome of the A-HEFT trial involving African-American patients?

A

A: The trial was terminated early as isosorbide dinitrate and hydralazine were superior to placebo.

39
Q

Q: How does sacubitril work in the context of heart failure treatment?

A

A: Sacubitril inhibits neprilysin, leading to increased cardiac natriuretic peptides which oppose the effects of RAAS by increasing salt and water excretion.

40
Q

Q: What is the mechanism of action of ivabradine?

A

A: Ivabradine inhibits the sinoatrial node (SAN) pacemaker current, slowing the heart rate.

41
Q

Q: How does hydralazine help in heart failure treatment?

A

A: Hydralazine interferes with IP3-stimulated calcium release from smooth muscle sarcoplasmic reticulum, reducing vascular resistance.

42
Q

Q: According to NICE guidelines, what is the first-line treatment for heart failure?

A

ACE inhibitors and beta-blockers

43
Q

Q: What should be used if ACE inhibitors are not tolerated in heart failure treatment?

A

A: Angiotensin II receptor blockers (ARBs).

44
Q

Q: What additional treatment is recommended if heart failure symptoms are not controlled by first-line treatments?

A

A: Spironolactone.

45
Q

Q: Name two more serious treatment options for heart failure if symptoms persist despite standard treatment.

A

A: Ivabradine and sacubitril/valsartan.

46
Q

Q: What is the recommended treatment for heart failure with preserved ejection fraction according to NICE guidelines?

A

A: Diuretics.

47
Q

Q: Name two examples of loop diuretics.

A

A: Furosemide and bumetanide.

48
Q

Q: What is the mechanism of action of loop diuretics?

A

A: They inhibit the transport of sodium (Na), potassium (K), and chloride (Cl) in the ascending limb of the Loop of Henle.

49
Q

Q: List three main uses of loop diuretics.

A

A: Heart failure, edema, and hypertension (especially when not responding to other drugs or in patients with kidney issues or heart failure).

50
Q

Q: What are some common side effects of loop diuretics?

A

A: Hypokalemia, high volume of urine, fatigue, headache, and muscle spasms.

51
Q

Q: Name three examples of thiazide and thiazide-related diuretics.

A

A: Bendroflumethiazide, chlortalidone, and indapamide.

52
Q

Q: What is the mechanism of action of thiazide diuretics?

A

A: They inhibit the transport of sodium (Na) and chloride (Cl) in the distal convoluted tubule.

53
Q

Q: What are the main uses of thiazide diuretics?

A

A: Low doses for hypertension, and higher doses for edema and sometimes heart failure.

54
Q

Q: What are some side effects of thiazide diuretics?

A

A: Hypokalemia, hypochloremia, moderately high volume of urine, fatigue, headache, gastrointestinal tract disturbances, and postural hypotension.

55
Q

Q: Name two examples of potassium-sparing diuretics.

A

A: Spironolactone and amiloride.

56
Q

Q: What is the mechanism of action of spironolactone?

A

A: It acts as an aldosterone antagonist.

57
Q

Q: How does amiloride work?

A

A: It blocks the epithelial sodium (Na) channel.

58
Q

Q: What are the main uses of amiloride?

A

A: It is added to loop and thiazide diuretics to prevent potassium loss.

59
Q

Q: List three main uses of spironolactone.

A

A: Treating edema in heart failure, adjunct treatment in moderate to severe heart failure, and adjunct in resistant hypertension.

60
Q

Q: What are some side effects of potassium-sparing diuretics?

A

A: Hyperkalemia, gastrointestinal tract disturbances, and more frequent urination.

61
Q

Q: What additional effects can high doses of spironolactone have?

A

A: It can act as an antiandrogen, causing feminization in men and disrupting the menstrual cycle in women.

62
Q

Q: Why is regenerative medicine focused on the use of stem cells?

A

A: Because stem cells have the potential to carry out extensive repairs or replace damaged tissues and organs.

63
Q

Q: Why is the zebrafish commonly used in regenerative medicine research?

A

A: Because it grows rapidly, has a simple heart, its genome has been sequenced, its embryos are transparent, and it is capable of significant organ repair and replacement.

64
Q

Q: What is the main advantage of using zebrafish for studying heart repair?

A

A: Many cell types and signaling pathways essential for zebrafish heart repair are also present in humans, offering insights that could help activate similar processes in human hearts.

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