Heart Failure and Cardiomyopathy Flashcards
Which of the following is not an exacerbating factor of heart failure?
a. Anemia
b. Emotional stress
c. Alcohol intake
d. Low sodium intake
d. Low sodium intake
True or false: NSAIDs help relieve fluid overload and in turn, help relieve symptoms of heart failure
False. NSAIDs play a role in sodium and water retention, exacerbating heart failure symptoms
Describe Stage A classification of heart failure
At risk for HF. Biomarkers and cardiomyopathy and other risk factors may be present, but no symptoms present
At what stage of heart failure is palliative care usually incorporated?
Stage D
At what stage of heart failure do symptoms usually present?
Stage C
What is the difference between functional classes of heart failure and stages of heart failure?
Staging moves in one direction. Functional classes are bidirectional
Examples of initial therapy
. Identify and treat etiology if possible
. Treat risk factors
. Remove exacerbating meds
. Low salt diet (<2-3 g/day)
. Monitor weight (>2lbs/day or >5lbs/week in fluid weight is concerning)
. Restrict fluid intake
What is the difference between ischemic and non ischemic HF?
Ischemic- damage due to blockage
Non ischemic- usually inherited cardiomyopathy. no blockage has lead to damage
Which of the following beta blockers is not used in heart failure?
a. Carvedilol
b. Labetalol
c. Metoprolol succinate
d. Bisoprolol
b. Labetalol
Which of the following classes is preferred in the treatment of HF?
a. ARNi
b. ACEi
c. ARBs
a. ARNi
In what cases are ARBs indicated in HF patients?
. Recent MI
. LVEF less than or equal to 40%
. Intolerant to ACEi
What symptoms indicate ACEi intolerance?
. Developing cough or angioedema
What drug is classified as an angiotensin II receptor and neprilysin blocker?
Sacubitril/Valsartan (Entresto)
Does switching from an ACEi to an ARNI require a wash out period? If yes, how long?
Yes. Wash out period of 36 hours
Does switching from an ARB to an ARNI require a wash out period? If yes, how long?
No
What ethnic group has the highest death rate per capita and higher hospitalization rate compared to white patients?
Non-Hispanic Black
What is heart failure?
Disorder in the ability of the heart to contract and/or relax, prohibiting the heart from ejecting enough blood
What is cardiomyopathy?
Disease that entails structural changes in the heart
What is the difference between heart failure and cardiomyopathy?
Cardiomyopathy- structural changes in the heart, no symptoms yet
Heart failure- symptoms of cardiomyopathy
What is systolic dysfunction?
Impairment in the ability of heart to contract
What is diastolic dysfunction?
Impairment in the ability of the heart to relax
What is considered mid range ejection fraction?
Between 40% - 50%
Patients with HTN are more likely to experience (systolic/diastolic) dysfunction
Diastolic
Ejection fraction that classifies HFrEF
40% and lower
Ejection fraction that classifies HFpEF
50% and greater
Systemic congestion, abdominal pain and jugular venous distention are signs and symptoms of (left/right) sided heart failure
Right
What are signs and symptoms of left sided heart failure?
. Pulmonary congestion (wet cough)
. Pulmonary rales and edema
. Dyspnea
When assessing inheritance of cardiomyopathy, how many generations of family history should be collected?
3 generations
What lab values and biomarkers should be assessed in HF patients?
. ECHO
. BNP or NT-proBNP
. Chest X-ray
. Cath report
. MRI
What is BNP and what does is indicate?
Brain natriuretic peptide. It is released when there is stretching in the ventricles, indicating cardiomyopathy
How is ejection fraction calculated?
Amount of blood pumped out of the ventricles (stroke volume) / Total amount of blood in relaxed ventricle (end-diastolic volume)
What are the 4 pillars of heart failure treatment?
. RAAS
. BB
. MRA
. SGLT2i
When titrating up to a target dose, adjustments occurs at every ___ - ___ weeks depending on hemodynamic parameters, symptoms, and laboratory data
2-4 weeks
True or false: An important monitoring parameter for an HF patient using Entresto is BNP
False. Pro-BNP levels must be taken, BNP not a good indicator for ARNi class
Which beta blockers are approved for use in HF treatment?
Carvedilol, Bisoprolol and Metoprolol succinate
Important monitoring parameter of beta blockers in diabetic patients
Can mask hypoglycemia symptoms in DM patient except sweating
What is an uncommon, but possible side effect of MRAs?
Hirsutism
Cautions of SGLT2i medications
. Increased risk of mycotic genital infections
. Necrotizing fasciitis of the perineum (Fournier’s gangrene)
Which of the following thiazide diuretics is preferred in patients with heart failure?
a. Metolazone
b. Hydrochlorothiazide
c. Chlrothalidone
a. Metolazone
BiDil generic name and MOA
Hydralazine/Isosorbide Dinitrate. Direct vasodilation of arterioles (hydralazine) and stimulation of intracellular cGMP (isosorbide dinitrate)
BiDil is contraindicated with concomitant use with which medication class?
PDE5 inhibitors. Sildenafil, tadalafil, vardenafil
When is ivabradine indicated in HF treatment?
For patients with resting Hr > or equal to 70, on maximally tolerated BB dose in NSR, class I/III
