Heart Failure

Question 1

What is diastolic HF also called of?

Answer 1

HF with preserved EF (HFpEF)

Question 2

What is systolic HF also called of?

Answer 2

HF with reduced EF (HFrEF)

Question 3

What are examples of loop diuretics?

Answer 3

Furosemide, Torasemide, Bumetanide, Etacrynic acid,

Question 4

Which transporter does loop diuretics working on?

Answer 4

Na+-K+-2Cl− symporter

Question 5

Common ADR of loop diuretics?

Answer 5

• hypoNa, hypoK, hypoMg
• dehydration,
• hyperuricemia, gout
• dizziness, postural hypotension, syncope

Question 6

in HFrEF, what is the 1st line drug to start with

Answer 6

• Diuretics or ACEi (or ARB) separately or together

Question 7

What’s the use of diuretics in treating HF?

Answer 7

• relieving sx of congestion
• improve response to ACEi/ARB
• reduce risk of decompensation with beta-blockage

Question 8

T of F, ACE and ARB can be used together in treating HF?

Answer 8

F - this combo increases mortality

Question 9

When do you start beta-blocker the HF patient?

Answer 9

• Once patient is STABLE on a loop diuretics and a ACEi/ARB

Question 10

What’s good about beta-blocker?

Answer 10

• Long-term benefits on hemodynamics (not short term)
• ## decrease maladapative effort

Question 11

Which two drug decrease maladapative effort of heart in HF?

Answer 11

• ACEi/ARB

- Beta-blocker

Question 12

What’s good about metoprolol versus carvedilol

Answer 12

Metoprolol - less hypotension

Question 13

When will you use aldosterone antagonist?

Answer 13

• NYHA II, III. IV with EF

Question 14

What to pay attention when on aldosterone antagonist?

Answer 14

Renal function and K level

Question 15

Which 1st line for black HF patients (NYHA class III or IV, with EF

Answer 15

• Hydralazine + Nitrates

Question 16

Digoxin effect in HF management?

Answer 16

Rate Control

- Carefully monitor digoxin level, as low level is with improved mortality, but level > 1.2 kills

Question 17

What presence of DM change management of HF?

Answer 17

No

Question 18

Any use of statin in managing HF patients?

Answer 18

NO

Question 19

If HF patients has angina or HTN, can they use CCB?

Answer 19

Yes, CCB is safe if there is another indication in the setting of HF (but not to HF itself)
- also safe in post-MI setting

Question 20

Give two examples of CCB?

Answer 20

Amlodipine, Nifedipine ‎Diltiazem, Verapamil

Question 21

What are examples of Dihydropyridine CCB?

Answer 21

Amlodipine, Nifedipine

Question 22

What’s the non-DHP CCB?

Answer 22

Diltiazem, Verapamil

Question 23

What’s special of Dhp CCB?

Answer 23

• “di” = “dead”
• works on both myocardium and vascular
• Vasodilator - reduce SVR -hypotension and relief of angina - however can cause reflex tachycardia -> detrimental for patients with ischemic symptoms

Question 24

What’s special of non-DHP ccb?

Answer 24

• “non” - is actually selective for myocardium only
• reduce myocardial oxygen demand and reverse coronary vasospasm -> treat angina
• minimal vasodilation effect, less or no reflex tachycardia