ELM14: Heart failure

Question 1

What are the two main problems resulting in a heart attack?

Answer 1

Heart doesn’t contract well
Heart doesn’t fill well

Question 2

What is the ejection fraction?

Answer 2

Percent of blood in ventricle ejected from heart each cycle

Question 3

What is the equation for ejection fraction?

Answer 3

100(stroke vol)/ventricle vol

Question 4

What is considered reduced ejection fraction?

Answer 4

Under 40%

Question 5

What are some risk factors causing reduced ejection fraction?

Answer 5

Previous heart attack
Diabetes
Hypertension
CAD
Male

Question 6

What is preserved ejection fraction?

Answer 6

Over 50% with low stroke volume

Question 7

What are some risk factors of preserved ejection fraction?

Answer 7

Hypertension
Hypertrophic cardiomyopathy
Female
Diabetes

Question 8

What are some characteristics of reduced ejection fraction?

Answer 8

Enlarged left ventricle
Weakened heart muscle

Question 9

What are some characteristics of preserved ejection fraction?

Answer 9

Thickened left ventricle wall
Small left ventricle
Thickened ventricular septum

Question 10

What are some genetic forms of heart failure?

Answer 10

Dilated cardiomyopathy
Hypertrophic cardiomyopathy

Question 11

What is dilated cardiomyopathy?

Answer 11

Enlarged baggy ventricle
Gives HFrEF 50% familial

Question 12

What is hypertrophic cardiomyopathy?

Answer 12

Ventricle has thick muscle wall causing filling problems
Autosomal dominant

Question 13

Where do cardiomyopathy mutations usually form?

Answer 13

Actin
Myosin
MLCK
Titin

Question 14

What are some symptoms of left forward heart failure?

Answer 14

Easily tired
Cyanosis
Underperfused kidney

Question 15

What are some symptoms of left backwards heart failure?

Answer 15

Pulmonary oedema

Question 16

What are some symptoms of right forward heart failure?

Answer 16

Easily tired

Question 17

What are some symptoms of right backward heart failure?

Answer 17

Engorged liver and spleen
Peripheral oedema
Pulmonary effusion

Question 18

What is the process of decompensation?

Answer 18

1. Body interprets low cardiac output as haemorrhage and compensates
2. Compensation is maladaptive
3. Decompensation occurs

Question 19

What was the CONSENSUS study?

Answer 19

Cooperative north scandinavian enalapril survival study
Studies of left ventricular dysfunction ACE inhibitors help survival

Question 20

What was the COMET CIBIS II trial?

Answer 20

Cardiac insufficiency bisoprolol trial II
Carvedilol or metoprolol european trial
Bisoprolol improves survival Carvedilol better than metoprolol

Question 21

What was the RALES trial?

Answer 21

Randomised aldactone evaluation study
Spironolactone improves survival

Question 22

What was the CHARM trial?

Answer 22

Candesartan in heart failure assessment of reduction in mortality and morbidity
ARBS are good

Question 23

What was the PARADIGM-HF study

Answer 23

Prospective comparison of ARNI with ACEI to determine impact on global mortality and morbidity in heart failure
ANRI superior to ACEI

Question 24

What was the SHIFT trial?

Answer 24

Systolic heart failure treatment with the IF inhibitor ivabradine trial
Ivabradine reduced deaths

Question 25

What was the A-HEFT trial?

Answer 25

African american heart failure trials
Isosorbide dinitrate and hydralazine superior

Question 26

What is sacubitril?

Answer 26

Cardiac natriuretic peptide
Oppose effects of RAAS
Increase salt and water excretion Inhibits neprilysin

Question 27

What is ivabradine?

Answer 27

Inhibits SA node pacemaker current
Slows heart

Question 28

What is hydralazine?

Answer 28

Interferes with IP3 stimulated Ca2+ release from smooth muscle SR