Heart Failure

Question 1

E/A 1.0 - 1.5

Answer 1

Normal diastolic fx

Question 2

E/A <1

Answer 2

Grade I diastolic dysfunction

Question 3

E/A 0.8-1.5

Answer 3

Grade II diastolic dysfunction (Pseudonormal)

Question 4

E/A >2

Answer 4

Grade III (Reversible restricted)
Grade IV (Fixed restricted)

Question 5

Drug therapy that precipitate/exacerbate HF

Answer 5

1) Negative inotropes (diltiazem/verapamil)
2) Corticosteroids
3) NSAIDs
4) Thiazolidinediones (T2DM)
5) Chemotherapy agents
> Anthracyclines
> Trastuzumab

Question 6

Changes to cardiac myocytes during heart failure

Answer 6

• Decreased sarcoplasmic reticulum Ca2+ ATPase activity
• Decreased alpha myosin, increased beta myosin production

Question 7

HFrEF pharmacological therapy

Answer 7

• ACEi/ARB or ARNI
• Beta blocker
• Mineralocorticoid receptor antagonist (spironolactone or eplerenone)
• SGLT2 inhibitor

Other:
- Ivabradine
- Vericiguat
- Iron infusion (can improve symptoms, not mortality benefit)

Question 8

Ivabradine indications

Answer 8

LVEF <40%
Sinus rhythm
HR >70bpm despite maximal beta-blocker therapy

Question 9

Where is BNP produced?

Answer 9

Heart ventricles (majority)
+ brain

Pro-BNP released into bloodstream, cleaved by protein –> NT-proBNP and BNP

Question 10

What can increase BNP?

Answer 10

Age
Female
ARNIs (measure NT-proBNP)
CAD
Valvular disease
Pulmonary HTN
CKD
Sepsis

Question 11

Mortality benefit pharmacotherapy in HFpEF

Answer 11

SGLT2 inhibitors

Question 12

How does GTN improve APO?

Answer 12

Decreases preload