Heart Failure

Question 1

Definition of heart failure

Answer 1

Clinical syndrome with current or prior a structural or functional impairment of the heart WITH either raised BNP and objective evidence of pulmonary/systemic congestion

Question 2

Washout period when transitioning from ACEi to ARNI? and why?

Answer 2

36hrs washout period - studies showed an associated risk of development of angioedema

Question 3

Indication for starting ivabradine in eCCF and the study showing it’s indication

Answer 3

SHIFT study-
Showed improvement when commenced in HFrEF <35% and HR up to 70bpm with SR after ACEi and B-blocker with/without MRA.
This showed reduced cardiac mortality and hospitalizations

Question 4

When should you consider advanced heart failure therapies

Answer 4

1.NYHA 3-4 sx
2.Recurrent Hospital Admissions
3.Episodes of vascular congestion
4. These sx persist despite optimised therapy

Question 5

What are the type of beta blockers in the market?

Answer 5

Beta-1 receptor-selective blockers like atenolol, bisoprolol, metoprolol, and esmolol only bind

Non-selective agents bind to both beta-1 and beta-2 receptors and induce antagonizing effects via both receptors. Examples include propranolol, carvedilol, sotalol, and labetalol.

Question 6

What defect is associated with Hypertrophic Obstructive Cardiomyopahty?

Answer 6

the most common defects involve a mutation in the gene encoding
i.β-myosin heavy chain protein ii.myosin-binding protein C

Question 7

What are the ECHO findings associated with HOCM

Answer 7

Echo findings - mnemonic - MR SAM ASH
mitral regurgitation (MR)
systolic anterior motion (SAM) of the anterior mitral valve leaflet
asymmetric hypertrophy (ASH)

Question 8

What is the mechanism of action of Nicorandil

Answer 8

The correct answer is Potassium-channel activator. Nicorandil is a vasodilatory drug that acts as both
i.a nitrate
ii.non-selective potassium channel activator. It opens up ATP-sensitive potassium channels in the smooth muscle of coronary and peripheral blood vessels, leading to hyperpolarisation and relaxation.

This results in an increase in blood flow to the myocardium (heart muscle) and a reduction of the heart’s workload, thus alleviating angina symptoms.

Side effects include:
dizziness, nausea, vomiting and headache. This ulceration may occur anywhere along the gastrointestinal tract

Question 9

What are the pathological findings found in HOCM

Answer 9

Myofibrillar hypertrophy, myocyte disarray and interstitial fibrosis

Question 10

mechanism of action of ACE-i

Answer 10

Mechanism of action:
inhibits the conversion angiotensin I to angiotensin II
→ decrease in angiotensin II levels → to vasodilation and reduced blood pressure
→ decrease in angiotensin II levels → reduced stimulation for aldosterone release → decrease in sodium and water retention by the kidneys
renoprotective mechanism
angiotensin II(which effects have been decreased) constricts the efferent glomerular arterioles
ACE inhibitors therefore lead to dilation of the efferent arterioles → reduced glomerular capillary pressure → decreased mechanical stress on the delicate filtration barriers of the glomeruli
this is particularly important in diabetic nephropathy
ACE inhibitors are activated by phase 1 metabolism in the liver

Question 11

In the event of Native valve endocarditis what is the most likely infective organism, and best therapy

Answer 11

Most likely Staphy Aureus.
Ideal blind therapy would be
IV Amoxicillin and IV gentamycin

Question 12

Mechanism of action of Vericiguat?

Answer 12

This is a novel sGC stimulator that enhances cyclic GMP and NO signaling by stimulating sGC and sensitizing sGC to enodgenous NO

Question 13

What are the effects of BNP?

Answer 13

Effects of BNP
i.vasodilator
ii.diuretic and natriuretic
iii.suppresses both sympathetic tone and the renin-angiotensin-aldosterone system