heart failure

Question 1

HF

Answer 1

A mismatch between right and left heart volume

outputs”

Question 2

left side failure

Answer 2

becomes cecexic. backs up in lungs and coughs

Question 3

right heart failure

Answer 3

builds up fluid in abdomen (ascites)

Question 4

systolic hf

Answer 4

decrease contractility. decrease EF. patients tend to be younger. dialated hearts

Question 5

diastolic HF

Answer 5

decrease ventricular filling decrease CO. cannot fill because its stiff. older patients. hypertrophied heart

Question 6

main hf causes

Answer 6

ischemia, idiopathic, viral, immune mediated, htn

Question 7

ischemic HF

Answer 7

Can contribute to both systolic and diastolic
dysfunction
• Most common (~70%?) type of HF in
America.

Question 8

2) Idiopathic HF

Answer 8

Familial? (~ 1/3?)
• Toxins?
• Parasitic?
• Undiagnosed viral?
• Pregnancy-related?

Question 9

3) Viral HF

Answer 9

Viral” (another term for “idiopathic)
• Many, many viruses implicated. Viruses “errantly” take up residence in
myocardial cells…
• Moderate/severe cardiomyopathy (what’s
this?) develops…
• …and may or may not fully or completely
resolve (eventually)
• Might require valvular Sx due to new
cardiac “geometry

Question 10

Immune-Mediated HF

Answer 10

Specific cardiac antibodies attack
cardiomyocytes
• Possible link to other immune-mediated
diseases (like what?) LUPUS RHEUMATOID ARTHRITIS
• Acute myocardial infarctions (AMIs) may
expose novel cardiac antigens affecting
long-term prognosis. inside of heart is supposed to be inside and body will develop immune response to heart

Question 11

why does the heart remodel

Answer 11

Heart cells die…
…they’re replaced with
fibrotic tissues…
…and remaining cells
hypertrophy

Question 12

What forces contribute to the chronic

downhill HF slide?

Answer 12

chronic sympathetic stim. and renin angiotensin aldosterone system

Question 13

goals of therapy for HF

Answer 13

1) Improve/alleviate critter’s symptoms
• 2) Slow that “downhill slide” towards
transplant/VAD/death
• 3) Improve survival
***Increase critter’s QALYs*

Question 14

six classes of QALY improving drugs

Answer 14

1) Positive Inotropes
2) Diuretics
3) Renin/Angiotensin Blockers
4) Primary Vasodilators
5) β-Blockers
6) Aldosterone Antagonists
7) Neprilysin Inhibitor (the future?)

Question 15

positive inotropes

Answer 15

Cardiac Glycosides

• Catecholamines
• Bipyridines

Question 16

digitalis

Answer 16

digoxin. cardiac glycoside. Positive Inotrope
• Negative Chronotrope
• Increased Baroreceptor
sensitivity. *Narrow therapeutic window
-Arrhythmias, GI symptoms
*No evidence these
drugs prolong life!

Question 17

how doe digitalis work

Answer 17

Blocks Na⁺/K⁺-ATPase “The Sodium Pump”

…and you know what THAT causes! increase NA INCREASE CA increase contraction

Question 18

PREFERRED DRUG FOR CARDIAC

ARREST!!

Answer 18

Epinephrine (Adrenaline). Also handy for anaphylactic (what’s this?)
reactions
-Predictable side effects.

Question 19

Dopamine

Answer 19

A relatively non-specific catecholamine; acts
on dopaminergic receptors
• Improves cardiac function in heart failure.
• Also used for renal failure
and shock
• Given by IV drip infusion

Question 20

DOBUTAMINE

Answer 20

Also acts on dopaminergic receptors but

more cardioselective

Question 21

Bipyridines what they do to the body

Answer 21

increase intracelular levels of cAMP =
increase intracellular levels of Ca⁺⁺ =
increase myocardial contractility

Question 22

bipyridines long term use results in

Answer 22

significantly higher mortality than that seen in untreated
patients!
*ONLY used in short-term (acute) HF patients…

Question 23

Frequently the D.O.C. at all stages of HF,
particularly in patients with low EF (what’s
this? what’s normal?)

Answer 23

Renin-Angiotensin Converting
Enzyme Blockers. Initiation of ACE-Inhibitor Rx after AMIs
is widely considered a standard of care**
-Often used as part of a progressive multimodal
Rx (huh?..we’ll discuss in a minute

Question 24

losartan

Answer 24

cozaar. arb s. used as a replacement for ACE inhibitor in intolerant patientsmay also be used with ace inhibitors in decompensating patients

Question 25

D.O.C. venous dilators

for acute CHF episodes

Answer 25

nitrates

Question 26

patients intolerant of ace inhibitors and arbs or beta blockers. give

Answer 26

hydralazine or isosorbide

Question 27

Why would you be giving negative

inotropes to patients in HF?

Answer 27

block chronic sympathetic stimulation and prevent apoptosis of myocyte. not for acute HF

Question 28

aldosterone antagonist

Answer 28

prevent salt fluid retention myocardial hypertrophy and decrease K excretion. improve long term mortality

Question 29

lcz 696

Answer 29

A 50/50 mix of Valsartan (about which you
have a perfect & complete understanding)
and Sacubitril
• Sacubitril is metabolized into a neprilysin
inhibitor

Question 30

Neprilisyn

Answer 30

an enzyme which breaks down
atrial (ANP) & brain (BNP) natriuretic
peptides
• ANP is mostly released in response to
excessive blood volume (mostly in response
to excessive atrial “stretch”) and causes an
increase GFR, increase sodium loss, and decrease renin secretion

Question 31

morphine. acute HF

Answer 31

Classically used in
acute heart failure to
reduce preload, heart
rate, and (maybe?)
afterload.
• NO evidence it helps;
substantial evidence it
produces worse longterm
outcomes

Question 32

morphine chronic HF

Answer 32

– Lowers respiratory
rate which decreases
cardiac workload
– Decreases preload and
afterload (some…a
good reason to say why
you’re giving
morphine…)
– EASES ANXIETY! Do
you understand where
we’re going with thiS?

Question 33

RHF SYMPTOMS

Answer 33

FATIGUE, INCREASE PERIPHERAL RESISTANCE,ENLARGED LIVER SPLEEN,DISTENDED JUGULAR VEIN, ANOREXIA,GI DIDTRESS, SWELLING IN HANDS DEPENDENT EDEMA

Question 34

LEFT SIDED FAILURE

Answer 34

PAROXYSMAL NOCTURNAL DYSPNEA PULMONARY CONGESTION,CONFUSION,FATIGUE, RESTLESSNESS, CYANOSIS,ORTHOPNEA, Tachycardia