Heart Failure Flashcards

1
Q

HRrEF impairment in cardiac function

A

systolic dysfunction: decreased contractility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

HFpEF impairment in cardiac function

A

diastolic dysfunction: impairment in ventricular relaxation/filling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

HFrEF definition

A

HF symptoms with EF < 40%
(could be asymptomatic reduced EF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

HFpEF definition

A

HF symptoms with EF > 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

70% of HFrEF cases are caused by ____________ ___________ _______________

A

ischemic dilated cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

3 determinants of left ventricular function:

A
  1. Preload (venous return, LVEDV)
  2. Myocardial contractility (force generated at any given LVEDV)
  3. Afterload (aortic impedance and wall stress)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Drug-induced heart failure: negative ionotropics

A
  1. Antiarrhythmics (disopyramide, flecainide)
  2. B-blockers
  3. CCBs (non-DHP)
  4. Itraconazole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Drug-induced heart failure: direct cardiac toxins

A

Doxorubicin, Bevacizumab, blue cohosh, imatinib, ethanol, cocaine, amphetamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Drug-induced heart failure: sodium/water retention

A

Glucocorticoids, androgens, estrogens, NSAIDs, COX2 inhibitors, rosiglitazone and pioglitazonee, Na+ containing drugs (i.e. carbenicillin DiNa+)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Clinical presentation of HF examples

A

SOB
swelling of feet/legs
difficulty sleeping due to breathing problems swollen abdomen with loss of appetite
cough with frothy sputum
increased urination at night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Right ventricular failure: S/Sx
(systemic venous congestion)

A

Sx: abdominal pain, nausea, bloating, constipation, anorexia

Signs: peripheral edema, JVD, HJR, hepatomegaly, ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Left ventricular failure: S/Sx
(pulmonary congestion)

A

Sx: dyspnea on exertion, orthopnea, bendopnea, PND, tachypnea, cough

Signs: rales, pulmonary edema, pleural effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Other major non-specific HF findings

A
  1. Fatigue/weakness
  2. Exercise tolerance
  3. Nocturia
  4. Cardiomegaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

BNP > ______ pg/mL may be indicative of heart failure

A

> 35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

NT-proBNP > ______ pg/mL may be indicative of heart failure

A

> 125

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

HF NYHA classes

A

I: cardiac disease w/o resulting limitations of physical activity
II: cardiac disease resulting in slight limitations of physical activity
III: cardiac disease resulting in limitations of physical activity
IV: cardiac disease resulting in inability to carry on any physical activity w/o discomfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

HF AHA Stage A

A

High risk of developing HF (HTN, CAD, DM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

HF AHA Stage B

A

structural heart disease that is strongly associated with HF but NO s/sx of HF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

HF AHA Stage C

A

current or prior symptoms of HF associated with underlying heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

HF AHA Stage D

A

advanced structural heart disease and marked symptoms of HF at rest despite maximal medical therapy and require specialized interventions

21
Q

NYHA FC I is equal to which AHA stage?

22
Q

AHA stage C is equal to which NYHA classes?

A

NYHA II + III

23
Q

NYHA FC IV is equal to which AHA stage?

24
Q

Asymptomatic rEF is what stage and what class?

A

Stage B
NYHA FC I

25
What drugs reduce intravascular volume?
diuretics, SGLT2i
26
What drugs increase myocardial contractility?
positive inotropes
27
What drugs decrease ventricular afterload?
ACEi vasodilators SGLT2i
28
What are the 5 GDMT drug classes?
1. ARNI/ACEi/ARB 2. Beta-blocker (metoprolol succ, carvedilol, bisoprolol) 3. aldosterone antagonist 4. SGLT2i 5. Loop diuretic
29
Mechanism of action of aldosterone antagonists IN HF
block aldosterone's effects and reduce cardiac remodeling (NOT used for diuretic effect in HF)
30
What are the 3 beta-blockers used for HFrEF?
Carvedilol Bisoprolol Metoprolol succinate
31
Diuretics do not decrease _________, but instead decrease hospitalizations
mortality
32
Patients w/o symptoms of ________ ___________ should not receive diuretics
volume overload
33
What is an additional benefit of loop diuretics for HFrEF patients?
enhances renal release of prostaglandins, which increases renal blood flow and enhances venous capacitance
34
Furosemide 80mg PO = ______ mg IV
40
35
Furosemide 40mg IV = bumetanide ______mg IV
1mg
36
Bumetanide 1mg IV = Torsemide ______ mg IV
20
37
Thiazide diuretics may be used in what patients?
Mild HF patients Pts with small amounts of fluid retention
38
Furosemide usual dose range
20-160mg QD or BID
39
Bumetanide usual dose range
1-2mg QD or BID
40
Torsemide usual dose range
10-80mg QD
41
HCTZ initial + maximum dose in HF
initial: 25mg/day max: 100mg/day
42
Metolazone initial + maximum dose in HF
initial: 2.5mg/day max: 10mg/day
43
Thiazides can cause ______calcemia while loops may cause ______calcemia
Thz = hyper Loop = hypo
44
Hypotension and increase SCr or BUN/Cr ratio may be indicative of what?
Volume depletion (BUN/Cr > 20:1 indicates dehydration and prerenal azotemia)
45
BUN/Cr normal ratio
15:1
46
While taking a thiazide, replace K+ if below _____mEq/L and replace Mg2+ if below _____mEq/L
K+ < 4mEq/L Mg2+ < 2mEq/L
47
Why is treating hypokalemia and hypomagnesemia important in HF patients?
Because they can cause pump failure and arrhythmias if left untreated
48
What is one of the most important benefits of ACE inhibitors for HF patients?
inhibition of cardiac hypertrophy/reduction in remodeling
49