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iPTX > Heart Failure and Cardiomyopathy > Flashcards

Heart Failure and Cardiomyopathy Flashcards

1
Q

Which of the following is not an exacerbating factor of heart failure?
a. Anemia
b. Emotional stress
c. Alcohol intake
d. Low sodium intake

A

d. Low sodium intake

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2
Q

True or false: NSAIDs help relieve fluid overload and in turn, help relieve symptoms of heart failure

A

False. NSAIDs play a role in sodium and water retention, exacerbating heart failure symptoms

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3
Q

Describe Stage A classification of heart failure

A

At risk for HF. Biomarkers and cardiomyopathy and other risk factors may be present, but no symptoms present

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4
Q

At what stage of heart failure is palliative care usually incorporated?

A

Stage D

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5
Q

At what stage of heart failure do symptoms usually present?

A

Stage C

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6
Q

What is the difference between functional classes of heart failure and stages of heart failure?

A

Staging moves in one direction. Functional classes are bidirectional

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7
Q

Examples of initial therapy

A

. 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

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8
Q

What is the difference between ischemic and non ischemic HF?

A

Ischemic- damage due to blockage
Non ischemic- usually inherited cardiomyopathy. no blockage has lead to damage

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9
Q

Which of the following beta blockers is not used in heart failure?
a. Carvedilol
b. Labetalol
c. Metoprolol succinate
d. Bisoprolol

A

b. Labetalol

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10
Q

Which of the following classes is preferred in the treatment of HF?
a. ARNi
b. ACEi
c. ARBs

A

a. ARNi

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11
Q

In what cases are ARBs indicated in HF patients?

A

. Recent MI
. LVEF less than or equal to 40%
. Intolerant to ACEi

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12
Q

What symptoms indicate ACEi intolerance?

A

. Developing cough or angioedema

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13
Q

What drug is classified as an angiotensin II receptor and neprilysin blocker?

A

Sacubitril/Valsartan (Entresto)

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14
Q

Does switching from an ACEi to an ARNI require a wash out period? If yes, how long?

A

Yes. Wash out period of 36 hours

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15
Q

Does switching from an ARB to an ARNI require a wash out period? If yes, how long?

A

No

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16
Q

What ethnic group has the highest death rate per capita and higher hospitalization rate compared to white patients?

A

Non-Hispanic Black

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17
Q

What is heart failure?

A

Disorder in the ability of the heart to contract and/or relax, prohibiting the heart from ejecting enough blood

18
Q

What is cardiomyopathy?

A

Disease that entails structural changes in the heart

19
Q

What is the difference between heart failure and cardiomyopathy?

A

Cardiomyopathy- structural changes in the heart, no symptoms yet
Heart failure- symptoms of cardiomyopathy

20
Q

What is systolic dysfunction?

A

Impairment in the ability of heart to contract

21
Q

What is diastolic dysfunction?

A

Impairment in the ability of the heart to relax

22
Q

What is considered mid range ejection fraction?

A

Between 40% - 50%

23
Q

Patients with HTN are more likely to experience (systolic/diastolic) dysfunction

A

Diastolic

24
Q

Ejection fraction that classifies HFrEF

A

40% and lower

25
Q

Ejection fraction that classifies HFpEF

A

50% and greater

26
Q

Systemic congestion, abdominal pain and jugular venous distention are signs and symptoms of (left/right) sided heart failure

A

Right

27
Q

What are signs and symptoms of left sided heart failure?

A

. Pulmonary congestion (wet cough)
. Pulmonary rales and edema
. Dyspnea

28
Q

When assessing inheritance of cardiomyopathy, how many generations of family history should be collected?

A

3 generations

29
Q

What lab values and biomarkers should be assessed in HF patients?

A

. ECHO
. BNP or NT-proBNP
. Chest X-ray
. Cath report
. MRI

30
Q

What is BNP and what does is indicate?

A

Brain natriuretic peptide. It is released when there is stretching in the ventricles, indicating cardiomyopathy

31
Q

How is ejection fraction calculated?

A

Amount of blood pumped out of the ventricles (stroke volume) / Total amount of blood in relaxed ventricle (end-diastolic volume)

32
Q

What are the 4 pillars of heart failure treatment?

A

. RAAS
. BB
. MRA
. SGLT2i

33
Q

When titrating up to a target dose, adjustments occurs at every ___ - ___ weeks depending on hemodynamic parameters, symptoms, and laboratory data

A

2-4 weeks

34
Q

True or false: An important monitoring parameter for an HF patient using Entresto is BNP

A

False. Pro-BNP levels must be taken, BNP not a good indicator for ARNi class

35
Q

Which beta blockers are approved for use in HF treatment?

A

Carvedilol, Bisoprolol and Metoprolol succinate

36
Q

Important monitoring parameter of beta blockers in diabetic patients

A

Can mask hypoglycemia symptoms in DM patient except sweating

37
Q

What is an uncommon, but possible side effect of MRAs?

A

Hirsutism

38
Q

Cautions of SGLT2i medications

A

. Increased risk of mycotic genital infections
. Necrotizing fasciitis of the perineum (Fournier’s gangrene)

39
Q

Which of the following thiazide diuretics is preferred in patients with heart failure?
a. Metolazone
b. Hydrochlorothiazide
c. Chlrothalidone

A

a. Metolazone

40
Q

BiDil generic name and MOA

A

Hydralazine/Isosorbide Dinitrate. Direct vasodilation of arterioles (hydralazine) and stimulation of intracellular cGMP (isosorbide dinitrate)

41
Q

BiDil is contraindicated with concomitant use with which medication class?

A

PDE5 inhibitors. Sildenafil, tadalafil, vardenafil

42
Q

When is ivabradine indicated in HF treatment?

A

For patients with resting Hr > or equal to 70, on maximally tolerated BB dose in NSR, class I/III

iPTX (18 decks)

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