Heart Failure

Question 1

What is cardiac failure?

Answer 1

the heart is incapable of maintaining a CO adequate to accommodate metabolic requirements of the body.

Question 2

What is a important cause of CF in the US?

Answer 2

systemic hypertension

Question 3

What is the most frequent cause of diastolic cardiac dysfunction?

Answer 3

LVH, usually caused by HTN

Question 4

How can we prevent CF in patients at stage A (HTN, CAD, structural abnormalities of myocardium) risk?

Answer 4

aggressive treatment of HTN, modifying coronary risk factors, reduce alcohol intake

Question 5

How can we prevent CF in patients with stage B (hx of MI, reduced systolic function, LVH, valvular dysfunction?

Answer 5

ACE and B-blocker for 1st 2

early surgery for the other 2

Question 6

What are the major symptoms of left sided failure?

Answer 6

SOB, chronic non-productive cough, nocturia, fatigue, exercise intolerance

Question 7

What are the major symptoms of right sided failure?

Answer 7

fluid retention, dependent edema of LE, loss of appetite, nausea

Question 8

What are common physical exam findings of a patient with CF?

Answer 8

Tachycardia, hypotension, reduced pulse, expiratory wheezes, rhonchi, or lung base crackles, thyroid abnormalities

Question 9

What would be significant lab findings of CF?

Answer 9

high levels of troponin, anemia with high RDW, hypokalemia, hyponatremia, TSH hyper or hypo

Question 10

What imaging techniques will help diagnosis? what will you see?

Answer 10

EKG - arrhythmia, MI, LVH
CXR - cardiomegaly, pleural effusions
Echo - size and function of all 4 chambers
cardiac cath - presence and extent of CAD

Question 11

What are the treatment goals for CF?

Answer 11

symptom relief, improving functional status, preventing death (ACE and b-block reduce mortality) and hospitalizations

Question 12

What is the most effective means of providing symptomatic relief to patients with moderate to severe HF?

Answer 12

diuretic therapy (loop most commonly)

Question 13

What should be the initial treatment in most symptomatic patients with HF and reduced LV EF?

Answer 13

combination of diuretic, ACE inhibitor with b-blocker

Question 14

what other condition can be managed with a beta-blocker in a patient with HF?

Answer 14

hypertension!

Question 15

What are the names of 2 drugs classified as beta-blockers and used for HF tx?

Answer 15

Carvedilol and metoprolol

Question 16

Which drug type should be avoided in the treatment of HF?

Answer 16

calcium-channel blockers, because can increase contraction. But they can be used to treat other things in HF patients (amlodipine, felodipine)

Question 17

How do vasodilators help treat a patient with HF?

Answer 17

decrease cardiac preload and after load

Question 18

What are 2 commonly used vasodilators in HF?

Answer 18

Nitrates and hydrazaline. These with an ACE or b-blocker, are highly effective in African Americanwith CHF

Question 19

What drug should be added for patients who remain symptomatic when taking diuretics and ACEI, as well as for patients with heart failure who are in Afib and require rate control?

Answer 19

Digoxin

Question 20

In which patients is digoxin contraindicated?

Answer 20

patients with diastolic or right-sided heart failure

Question 21

How does digoxin work? and what are it’s side effects?

Answer 21

It’s a positive inotropic agent (increase CO) by influencing sodium and calcium ion flow and more Ca stays in the cell increasing contractility. Because of this a common SE is arrhythmia. Others include: CNS (HA, confusion, blurred vision)

Question 22

Beside digoxin, what other inotropic agents are used to treat CF?

Answer 22

Dopamine, Dobutamine, Epinephrine

Question 23

What is an indication for dopamine?

Answer 23

is the drug of choice for cardiogenic and septic shock

Question 24

What is the drug of choice for acute heart failure in a hospital setting?

Answer 24

Dobutamine

Question 25

What is a side effect of Dobutamine?

Answer 25

Afib, because it increases AV conduction

Question 26

What is an indication for epinephrine?

Answer 26

anaphylactic shock, cardiac arrest

Question 27

What drugs does epinephrine interact with?

Answer 27

cocaine, b-blockers, inhalation anesthetics

Question 28

What is the major indication for Digoxin?

Answer 28

Heart failure with Afib

Question 29

A patient who has documented heart failure is unable to engage in physical activity without discomfort. What NYHA functional classification are they?

Answer 29

Class IV

Question 30

If a patient has no limitation in physical activity and ordinary activity does not cause symptoms, what NYHA class are they?

Answer 30

Class I

Question 31

If a patient has symptoms on activity, but are comfortable at rest, what NYHA classification are they?

Answer 31

Class III

Question 32

When is a beta-blocker contraindicated?

Answer 32

cardiogenic shock, symptomatic bradycardia, reactive airway disease, asthma

Question 33

If a patient is on amiodorone can you also put them on digoxin if indicated?

Answer 33

no - adverse drug interactions!