Heart Failure

Question 1

what is a disorder due to reduced cardiac output

Answer 1

systolic dysfunction ( acute)

Question 2

what are some compensatory mechanisms for heart failure

Answer 2

sympathetic nervous system and renin-angiotensin aldosterone response, and myocardial hypertrophy

Question 3

what are the most common causes of heart failure

Answer 3

coronary disease and hypertension ( other causes are MI, valvular heart disease, and congenital heart disease)

Question 4

what are some bfts of tx

Answer 4

reduced load on heart, decreased ec fluid volume, improved cardiac contractility, slower rate of cardiac remodeling

Question 5

what happens under diastolic failure

Answer 5

loss of adequate relaxation -> reduced filling, reduced cardiac output

Question 6

which is a disorder due to a result of hypertrophy and stiffening of the myocardium

Answer 6

diastolic dysfunction

Question 7

the actions of this molecule include potent vasoconstrictor, enhances release of catecholamines, increases synthesis of aldosterone ( leads to Na and water retention), and will also induce cardiac hypertrophy

Answer 7

angiotensin II

Question 8

this drug is used in pts with HF and/or atrial fibrillation ; pts who respond well to ACE inhibitors and/or diuretics do not need this drug; adverse effect is toxicity , cardiac arrhythmia , GI probs, anorexia, nausea, HA, fatigue, confusion, blurred vision, etc

Answer 8

digoxin

Question 9

symptoms of this disorder include dyspnea, fatigue, and fluid retention

Answer 9

heart failure

Question 10

what allow for the movement of actin and myosin filaments

Answer 10

interaction of activator CA with actin-troponin-tropomyosin system ( contraction occurs)

Question 11

what happens under systolic failure

Answer 11

reduced contractility

Question 12

where is activator Ca released from

Answer 12

SR ( amt released depends on the amt stored in the SR and on the amt of trigger Ca that enters the cell during the action potential)

Question 13

adaptive mechanisms work to restore the cardiac output; but if they increase the work of the heart and contribute to further decline in performance , HF is

Answer 13

decompensated HF

Question 14

decreased K levels increase toxicity in this drug

Answer 14

digoxin

Question 15

this type of inotropic drug comes from the digitalis plant ; has low therapeutic index

Answer 15

cardiac glycosides ie. digoxin

Question 16

reduction in physical activity, reduction in dietary intake of Na, treatment of comorbid conditions, medications, avoiding NSAIDS alcohol Ca channel blockers and high dose beta blockers and some antiarrhythmic drugs are used to manage

Answer 16

chronic HF

Question 17

what is associated with remodeling of cardiac tissue -> loss of myocytes, hypertrophy, and fibrosis

Answer 17

chronic activation of sympathetic nervous system and release of aldosterone

Question 18

what are the two goals tx of HF is aimed at

Answer 18

reducing symptoms and slowing progression, and managing acute epidoses of decompensated failure

Question 19

this compensatory mechanism is when a fall in cardiac output decreases blood flow to the kidney; this prompts the release of renin and increased circulation of aldosterone; results in increased peripheral resistance and retention of Na and water -> blood volume increases and pulmonary edema results

Answer 19

activation of renin-angiotensin system

Question 20

this is a system for controlling bp and electrolyte levels; monitors Na, K, vascular volume, and bp

Answer 20

renin-angiotensin-aldosterone system

Question 21

what converts angiotensinogen to angiotensin I

Answer 21

renin

Question 22

what happens to the heart as a result of compensatory mechanisms

Answer 22

heart becomes more spherical -> less efficient pump, prompts additional sympathetic activation

Question 23

this is an impaired ability of the heart to adequately fill with and/or eject blood

Answer 23

heart failure

Question 24

for tx of HF: all of these drugs are examples of what- inotropic agents, beta blockers, diuretics, inhibitors of renin angiotensin system, and vasodilators

Answer 24

effective drug classes

Question 25

this compensatory mechanism is when the baroreceptors sense a decrease in bp; this stimulates beta receptors to increase HR and force of cxn; alpha 1 mediated vasoconstriction enhances venous return

Answer 25

increased sympathetic activity

Question 26

HF can be accompanied by \_\_\_\_\_\_\_\_

Answer 26

abnormal increases in blood volume and interstitial fluid -\>pulmonary congestion/ and or peripheral edema

Question 27

this compensatory mechanism is when the heart increases in size ; becomes more globular and elongation of fibers results in weaker cxn

Answer 27

myocardial hypertrophy

Question 28

what causes a releaseof renin from the kidney

Answer 28

reduction in bp or fall in the delivery of Na to the nephron

Question 29

this is when the heart is unable to pump blood to meet the body's needs ( progressive and lethal)

Answer 29

heart failure

Question 30

long term use of these drugs has been found to increase mortality ; used short term as IV fusion for acute failure or severe chronic failure

Answer 30

inotropic drugs ( phosphodiesterate inhibitors)

Question 31

Dobutamine is the most common of these drugs and is given by IV infusion ; risk of angina or arrhythmias with this drug

Answer 31

beta adrenergic agonists ( inotropic drugs)

Question 32

this class of drugs relieves pulmonary congestion and peripheral edema ; causes decreased plasma volume and decreased venous return to the heart; reduction in plasma volume also reduces blood pressure

Answer 32

diuretics

Question 33

these type of diuretics are mild ; loose efficacy if pt creatinine clearance is low

Answer 33

thiazide diuretics

Question 34

what is the most common type of diuretic used for Heart failure

Answer 34

loop diuretics ie. furosemide

Question 35

Pts with heart disease have increased levels of \_\_\_\_\_\_\_

Answer 35

aldosterone

Question 36

What do Antagonists prevent

Answer 36

salt retention, myocardial hypertrophy, and hypokalemia ( pts should not take K supplements)

Question 37

Which aldosterone antagonists is reserved for advanced cases ? ; Causes GI disturbances, lethargy and confusion, decreased libido, menstrual irregularities

Answer 37

spironalactone

Question 38

Which aldosterone antagonist is the drug choice over spironalactone due to its lower side effects

Answer 38

eplenerone

Question 39

Heart failure leads to the activation of what system

Answer 39

renin angiotensin system

Question 40

Via what two mechanisms is the renin angiotension system activated

Answer 40

1. increased renin secretion in response to decreased renal perfusion pressured produced by the faiing heart 2. increased renin secretion as a response to sympathetic stimulation and activation of beta receptors

Question 41

T or F: Angiotension I is a potent vasoconstrictor

Answer 41

F: Angiotensin II is a potent vasoconstrictor

Question 42

Stimulation of Aldosterone release causes ______ and _________ retention

Answer 42

salt and water

Question 43

How do ACE inhibitors work

Answer 43

1. Angiotensin Converting Enzyme cleaves angiotension I to angiotension II 2. ACE inhibitors block the enzyme 3. Decrease the rate of bradykinin inactivation ( bradykinin is a potent vasodilator )

Question 44

What actions do ACE inhibitors have on the heart

Answer 44

1. decrease vascular resistance , venous tone, and bp 2. reduce preload and afterload ( increased cardiac output)

Question 45

These class of drugs are considered as a single agent therapy in pts who have mild dyspnea on exertion with no signs of edema; indicated in pts with all stages of L ventricular failure; can be used in combo with diuretics, beta blockers, digoxin, and aldosterone antagonists ; good after heart attack

Answer 45

ACE inhibitors

Question 46

Pharmacokinetics of thes class of drugs: food decreases absorption; most are pro drugs; Ramipirl and Fosinopril have longer half lives and are dosed once a day

Answer 46

Ace inhibitors

Question 47

Adverse effects of this class of drugs includes postural hypotension; persistent dry cough ; not to be used in pregnant women

Answer 47

ACE inhibitors

Question 48

These class of drugs are competitive antagonists of the angiotension receptor; do not affect bradykinin levels ; can substitute for ACE inhibitors if pt cant tolerate

Answer 48

Angiotension receptor blockers

Question 49

What are the actions that Angiotension receptor blockers have on the cardiovascular system

Answer 49

lower BP; used as substitute for ACE inhibitor in pts with severe cough or angioedema

Question 50

These class of drugs are most effective when taken orally ; once daily dosing; losartan is converted to active compound in liver metabolism ; plasma protein bound

Answer 50

Angiotension receptor blockers

Question 51

Adverse effects of this class of drugs are similar to ACE inhibitors ; includes postural hypotension; but NO persistent dry cough ; not to be used in pregnant women

Answer 51

Angiotension receptor blockers

Question 52

T or F: dilation of veins leads to an increase in cardiac output

Answer 52

F: leads to a decrease

Question 53

T or F: dilation of arteries reduce systemic resistance and decrease afterload

Answer 53

T

Question 54

Which drugs should be avoided in pts with heart failure

Answer 54

Ca channel blockers

Question 55

this class of drugs decreases chronic activation of the sympathetic nervous system ; decreases HR, inhibits renin release, and decreases cardiac remodeling; get initial worsening of symptoms ( negative inotropic activity )

Answer 55

beta blockers

Question 56

What are the two approved beta blockers to be used in heart failure

Answer 56

carvedilol and metoprolol