Heart Failure

Question 1

What is heart failure?

Answer 1

Inability of the heart to maintain enough cardiac output to meet the metabolic demands of the body

Question 2

What is the most common cause of heart failure?

Answer 2

Ischemia (CAD)

Question 3

What kind of cardiomyopathy does EtOH use cause leading to heart failure?

Answer 3

Dilated cardiomyopathy

Question 4

Definition of Stage A of the AHA/ACC Classification

Answer 4

Cardiac risk factors

Question 5

Definition of Stage B of the AHA/ACC Classification

Answer 5

Structural heart disease without HF

Question 6

Definition of Stage C of the AHA/ACC Classification

Answer 6

Structural heart disease with HF

Question 7

Definition of Stage D of the AHA/ACC Classification

Answer 7

End-stage HF

Question 8

What are the patient goals of heart failure therapy?

Answer 8

Improve mortality
Slow disease progression
Alleviate symptoms

Question 9

What are the physiological goals of heart failure therapy?

Answer 9

1. Reduce myocardial work - afterload and preload reduction
2. Improve output - contractility
3. Reduce morphological changes - remodeling

Question 10

Is there eccentric or concentric ventricular remodeling in systolic dysfunction (failure)?

Answer 10

Eccentric (myocytes elongate)

Question 11

Is there eccentric or concentric ventricular remodeling in diastolic dysfunction (failure)?

Answer 11

Concentric (myocytes thicken)

Question 12

Can systolic and diastolic heart failure co-exist?

Answer 12

Yes

Question 13

Increased preload leads to

Answer 13

Increased blood volume and increased venous tone

Question 14

Increased afterload is going to lead to

Answer 14

Increased TPR

Question 15

The release of this peptide creates the adverse effect of dry cough with use of ACEi?

Answer 15

Bradykinin

Question 16

What is the MOA of angiotensin II receptor blockers (ARBS)?

Answer 16

Directly block angiotensin II type 1 receptors

Question 17

What is the etiology of the adverse effect of hyperkalemia in the use of ARBS?

Answer 17

decreased aldosterone causes hyperkalemia

Question 18

What is a contraindication of B-blockers in regards to heart failure?

Answer 18

Acute HF, only recommended for chronic, stable HF

Question 19

B-blockers have been shown to improve survival after an MI due to what pharmacological effect?

Answer 19

It’s anti-arrhythmic effect of slowing conduction and automaticity, which decreases the risk of ventricular fibrillation

Question 20

Of the drug classes used for heart failure, what class has been shown to have the most benefit in decreasing mortality?

Answer 20

Beta-blockers

Question 21

What is the MOA of Hydralazine?

Answer 21

Exact MOA unknown

Selective dilation of arterioles –> decreased peripheral resistance and decreased BP

Question 22

What are the indications for Hydralazine?

Answer 22

• Arterial vasodilator
• Essential HTN, almost always used with a beta-blocker
• Used to decrease afterload in HF patients