heart failure Flashcards

1
Q

collapse- (muscle + pump)

  • Heart gives out –
  • -Can’t keep up with the demands of the body/
  • -Not pumping enough
  • _____ increases
  • _____ backs up in the system
A

inside pressure

fluid

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2
Q

CARDIAC OUTPUT= STROKE VOLUME × HEART RATE

  • SV depends on _____, _____ and _____
  • HR depends on _____ and _____ tone
A
preload 
afterload
contractility 
parasympathetic 
sympathetic
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3
Q

Where does the blood BACK-UP?

  • Preload is _____
  • Afterload is _____
A

high

high

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4
Q

LOW CARDIAC OUTPUT –HORMONAL REACTION OF THE BODY?

  • _____/_____?
  • _____?
  • Effect of Epinephrine on _____, _____ and _____
  • Name the receptors
  • Effect of RAAS on Preload
  • Stress on the heart?
A
epinephrine 
norepinephrine 
RAAS
afterload
contractility
heart rate
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5
Q

CHRONIC HEART FAILURE
-_____ – Pt is stable, fluid retention & pulmonary edema are absent

  • _____ – Pt deteriorates, may present as acute episode of _____ or as lethargy and malaise
  • A reduction in _____ tolerance and increasing _____ on exertion
A
compensated
DECOMPENSATED
pulmonary edema
exercise
breathlessness
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6
Q
  • Back-up in Veins of Lungs (_____ sided heart failure)
  • -_____ edema (_____) and Shortness of breath
  • Back-up in Veins of Feet and Lower Legs (_____ sided heart failure) and later in the _____
  • -Swelling and Ascites

-_____, Anxiety, _____

A
Left
Pulmonary
pleural effusion 
Right
Abdomen
Tiredness
palpitations
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7
Q

diagnosis

  • _____ (test of choice)- determines ejection fraction
  • Chest X ray
  • _____
  • _____ (polypeptide secreted by heart in response to excessive stretching of myocytes) almost always elevated in _____ HF
  • Normal BNP excludes CHF as a cause of _____
A
Echocardiography
Electrocardiogram
Brain Natriuretic peptide
decompensated
dyspnea
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8
Q

management of heart failure

  • NON-PHARMACOLOGIC –
    • Reduction of _____ intake
  • PHARMACOLOGIC –
  • -Drugs that lower mortality
  • -_____/_____
  • -_____ blockers
  • -_____ (or Eplerenone)
  • -_____ and Isosorbide nitrate
  • Drugs that decrease symptoms but do not lower mortality
  • -_____
  • -_____
A
salt
ACE
ARB
Beta
Spironolactone
Hydralazine
Digoxin
diuretics
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9
Q

ACE INHIBITORS /ARBS
ACE inhibitors –
-Recommended for all patients irrespective of _____ status, reduce _____ and _____ through _____

ARBs –
-Are acceptable alternatives in those unable to tolerate ACE inhibitors (cough, angioedema), block _____(AT1) _____

A
blood pressure
pre-load
after-load
vasodilation
type 1 angiotensin II 
receptors
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10
Q

BETA BLOCKERS – _____, _____
-Chronic adrenergic activation
-Decrease _____, reduce hospitalizations and improve functional class
-If beta blockers decrease heart rate and contractility, then don’t they also decrease cardiac output?
Wouldn’t that make CHF worse since it is a state of low CO?

A

CARVEDILOL
METOPROLOL
mortality

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11
Q

DIURETICS

  • DOC for acute _____ edema symptoms
  • Most commonly used is LOOP diuretic (_____)
  • Thiazides (_____) useful in mild HF
  • Aldosterone antagonists ( _____ and _____) is add on therapy to _____
A
pulmonary
Furosemide
Hydrochlorothiazide
Spironolactone
Eplerenone
ACE inhibitors
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12
Q

How about if we give the donkey some incentive to work harder?

  • Two types of drugs can increase the cardiac output
  • _____
  • _____ (Dobutamine and Milirinone)
A

Digoxin

Sympathomimetics

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13
Q

CARDIAC GLYCOSIDES – DIGITALIS

  • Positive _____ (HF) & Negative _____ (AF)
  • Improves symptoms
  • Improves QOF
  • Reduces hospitalizations but does not improve _____
  • Inhibits _____ resulting in increased intracellular concentration of Na+ and decreased exchanges of intracellular _____
  • Increase intracellular Ca2+ improves cardiac _____ (ie force and velocity)- promoting ventricular emptying
  • _____ and _____ compete for myocardium binding sites
  • _____ will decrease digitalis activity and _____ will result in toxicity
A
Inotropic
Chronotropic
survival
Na+/K+- ATPase pump
Ca2+
contractility
K+
Digitalis
Hyperkalemia
hypokalemia
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14
Q

DIGITALIS – USES

  • _____
  • _____/flutter
  • _____ (SVT)
A

CHF
Atrial fibrillation
Paroxysmal atrial tachycardia

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15
Q

TOXIC EFFECTS OF DIGITALIS

  • _____ and Vomiting
  • _____
  • _____
  • _____ halo around objects
  • _____ (tachy or brady)
  • MANAGEMENT – _____ (Digoxin-specificantibody(Fab) fragments)
A
Nausea
gynecomastia
blurred vision
Yellow
Arrhythmias
Digibind
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16
Q

DOBUTAMINE AND MILRINONE

  • _____, for a few days in advanced heart failure
  • ++ Sympathetic nervous system including _____ receptors
  • This increases heart rate and contractility = _____
  • Symptoms improve
  • ???Sympathetic ++ was bad in a pathologically diseased heart and will make things worse
  • _____ - long term
  • _____ term – they relieve symptoms
A
IV
Beta
INCREASED CO
yes it will
Short
17
Q

DOBUTAMINE
(a synthetic catecholamine)
-Pure _____; β1 > β2 > α receptor agonist
-Increase _____

MILRINONE

  • _____ inhibitor
  • Increase _____

-Chronic heart failure patients awaiting heart transplants are candidates for_____ support until the donor heart becomes available

A
adrenergic
intracellular Ca+
PDE
intracellular Ca+
intravenous inotropic
18
Q

ASPIRIN USE IN CHRONIC HEART FAILURE

  • Is Aspirin beneficial in CHF patients?
  • Is Aspirin potentially harmful in HF patients?
  • Is it reasonable to expect aspirin would be beneficial in CHF patient with underlying CAD?
  • Other safer options – Anticoagulant (_____) /Antiplatelet (_____, _____)
A

Warfarin
Clopidogrel
Ticagrelor