Heart Failure

Question 1

Characterized by a high risk for HF without structural heart disease or symptoms (i.e. hypertension, atherosclerosis, diabetes, obesity, etc.)

Answer 1

Stage A

Question 2

Structural heart disease without the development of HF

-Prior MI, depressed LV ejection fraction, LVH

Answer 2

Stage B

Question 3

Characterized by structural heart disease with current or prior symptoms

Answer 3

Stage C

Question 4

Classified as end-stage HF

Answer 4

Stage D

Question 5

The fraction of blood ejected by the ventricle relative to its end diastolic volume

Answer 5

Ejection Fraction

Question 6

How do we find ejection fraction?

Answer 6

EF = (SV / LVEDV) * 100

Question 7

Normally, ejection fraction is greater than

Answer 7

50-60%

Question 8

Preload is the myocardial stretch, which can be found as

Answer 8

Preload = EDV / /EDP

Question 9

Force of myocardial contraction and is independent of preload or afterload

Answer 9

Contractility

Question 10

Characterized by decreased capacity to eject blood due to decreased contractility

-LVEF is usually less than 40-50%

Answer 10

HF with Reduced EF

Question 11

Characterized by abnormal diastolic function due to increased stiffness

-LVEF is greater than 50%

Answer 11

HF with preserved EF

Question 12

Ventricles fill at higher than normal pressures with

Answer 12

HF w/ preserved EF

Question 13

When the RV becomes thin-walled and more compliant leading it to accept a wide range of volume w/out change in filling pressures

Answer 13

RV Failure

Question 14

The most common cause of RV failure is

Answer 14

LV failure

Question 15

If RV failure is due to lung process, we call it

Answer 15

Cor Pulmonale

Question 16

Has a limited benefit in severely decreased contractility

Answer 16

Frank-Starling Mechanism

Question 17

Serves to maintain perfusion to vital organs by increasing SVR and increasing intravascular volume

Answer 17

Neuro-Hormonal Activation

Question 18

The acute effects are beneficial but the chronic effects are deleterious

Answer 18

Neuro-Hormonal Activation

Question 19

Characterized by increasing sympathetic and decreasing parasympathetic output to the heart and periphery

Answer 19

Neuro-hormonal activation

Question 20

Cleaves angiotensinogen to AN-I

Answer 20

Renin

Question 21

Cleaves AN-I to AN-II

Answer 21

ACE

Question 22

A potent vasoconstrictor that stimulates thirst and increases aldosterone and Na retention, which thus increases volume

Answer 22

AN-II

Question 23

Secreted by the posterior pituitary and functions to increase water retention in distal nephron

Answer 23

ADH/Vasopressin

Question 24

Beneficial hormones that respond to stretch and increase Na+ and water retention

Answer 24

Natriuretic peptides (ANP and BNP)

Question 25

ANP and BNP promote

Answer 25

Vasodilation

Question 26

ANP and BNP inhibit

Answer 26

Renin secretion

Question 27

Used in diagnosis of HF

Answer 27

BNP levels

Question 28

Ventricular remodeling and hypertrophy reduces wall stress and maintains

Answer 28

Contractility

Question 29

Characterized by cardiac cachexia, tachypnea, and tachycardia with rales and decreased BS

Answer 29

Left sided HF

Question 30

We will see a diffuse apical impulse and a weak pulse with

Answer 30

Left sided HF

Question 31

Characterized by increased JVD and hepatic enlargement with ascites and leg edema

Answer 31

Right sided HF

Question 32

What labs suggest chronic HF?

Answer 32

Decreased Na and Hgb w/ increased creatinine

Question 33

Function in water and Na+ elimination which decreases intravascular and diastolic volumes

Answer 33

Diuretics

Question 34

The most potent diuretics are

Answer 34

Loop diuretics

Question 35

Less potent, but additive diuretics

Answer 35

Thiazides

Question 36

Venous vasodilators used to increase venous capacitance and decrease LV preload

Answer 36

Nitrates

Question 37

Arteriolar vasodilators used to decrease SVR which increases CO and thus increases BP

Answer 37

Hydralazine and Prazosin

Question 38

Balanced venous and arterial vasodilators

Answer 38

ACE inhibitors and ARBs

Question 39

Decrease AN-II and aldosterone while increasing bradykinins

Answer 39

ACE inhibitors

Question 40

Limit maladaptive remodeling and improves survival

Answer 40

ACE inhibitors

Question 41

Complete AN-II inhibition w/ no effect on bradykinins

Answer 41

ARBs

Question 42

Similar efficacy and survival benefit as ACE inhibitors, but can be an alternative if patient gets ACE-induced cough

Answer 42

ARBs

Question 43

Improve survival, especially in AA -Alternative if ACE inhibitor/ARB intolerant

Answer 43

Hydralazine/Nitrates

Question 44

Phosphodiesterase inhibitor used to increase ventricular contractility

Answer 44

Milrinone

Question 45

Blunts sympathetic drive and slows AVN conduction

Answer 45

Digoxin

Question 46

Inhibits Na+/K+ ATPase which increases intracellular Ca2+

Answer 46

Digoxin

Question 47

Improves symptoms and reduces hospitalizations, but has no effect on survival

Answer 47

Digoxin

Question 48

How do we treat patients with HF w/ reduced EF

Answer 48

Aldosterone Antagonists

Question 49

What are two examples of aldosterone antagonists?

Answer 49

Spironoloactone and eplerenone

Question 50

Blunt cardiac fibrosis and remodeling

Answer 50

Spironolactone and eplerenone

Question 51

In patients taking the aldosterone antagonists, we need to monitor

Answer 51

K+ levels

Question 52

When we have LVEF that is less than 35%, what can we use for SCD prevention?

Answer 52

AICD

Question 53

We want to avoid overdiuresis with

Answer 53

Right-sided HF

Question 54

The majority of patients with acute decompensated HF have what is classified as

Answer 54

Wet and Warm HF (Normal perfusion at rest w/ presence of congestion)

Question 55

The number one goal to treat wet and warm is

Answer 55

Diurese

Question 56

We want to keep wet and warm patients on

Answer 56

Beta-blockers

Question 57

May be added to diuretic therapy w/ wet and warm in absence of symptomatic hypotension and still w/ severe HF

Answer 57

Vasodilators

Question 58

Causes rapid improvement in congestion and is useful in pulmonary edema and severe hypertension

Answer 58

Vasodilators

Question 59

Peripheral edema means that the

Answer 59

Right side of heart is affected

Question 60

A low EF and low output syndrome w/ marginal BP and unresponsiveness to vasodilators

Answer 60

Wet and Cold HF

Question 61

Shows a poor response to diuretics and worsening renal function

Answer 61

Wet and Cold HF

Question 62

How do we treat patients w/ wet and cold HF?

Answer 62

IV inotropes

Question 63

Usually do not get admitted unless they are in end-stage

Answer 63

Patients with Dry and cold HF

Question 64

For dry and cold HF, what do we give if: 1. ) BP is ok? 2. ) BP is low?

Answer 64

1. ) Vasodilators | 2. ) Inotropes

Question 65

Characterized as stable and chronic HF

Answer 65

Dry and Warm HF

Question 66

In patients w/ advanced HF w/ reduced EF, are used in conjunction with ACE inhibitors

Answer 66

Beta-Blockers