Heart Failure-Malozzi

Question 1

Complex clinical syndrome that results from any structural or functional disorder that impairs the ability of the ventricle to fill with (HFpEF) or eject blood (HFrEF)

Answer 1

heart failure

Question 2

heart failure w/ ejection fraction above 50%

Answer 2

HFpEF

Question 3

heart failure with ejection fraction below 40%

Answer 3

HFrEF

Question 4

reduced EF is what kind of dysfunction

Answer 4

systolic

Question 5

preserved EF is what dysfunction

Answer 5

diastolic

Question 6

most common cause of heart failure

Answer 6

CAD or MI

Question 7

shortness of breath when lying down

Answer 7

orthopnea

Question 8

dyspnea on exertion
orthopnea
fatigue
fluid retention
tachycardia

Answer 8

sx’s of HF

Question 9

stage of HF where patient is at high risk for HF but without structural heart disease or sx’s

Answer 9

Stage A or I

Question 10

stage of HF where there is structural heart disease but without sx’s

Answer 10

Stage B or II

Question 11

stage of HF where there is structural heart disease WITH prior or current sx’s

Answer 11

Stage C or III

Question 12

advanced heart failure; requiring specialized interventions

Answer 12

Stage D or IV

Question 13

what acts as a compensatory mechanism in response to low CO and stroke volume

Answer 13

SNS

Question 14

3 things SNS stimulates

Answer 14

1. RAAS
2. adrenal medulla
3. hypothalamus

Question 15

effects of B1 stimulation (Gs)

Answer 15

increase inotropy, lusitropy, chronotropy

Question 16

effects of a1 stimulation (Gq)

Answer 16

increase in SVR, MAP
increase in preload

Question 17

effect of RAAS stimulation

Answer 17

increased renin release
increased Na+ and water retention

Question 18

effect of vasopressin

Answer 18

water reabsorption
peripheral vasoconstriction

Question 19

maldaptive responses due to the short term compensations that improve CO (3 things)

Answer 19

1. LV hypertrophy and remodeling
2. RAAS and ADH continued expression
3. downregulation/desensitization of B adrenergic receptors

Question 20

what leads to reduction in myocardial contractility

Answer 20

LV remodeling

Question 21

LV remodeling is in response to________

Answer 21

pressure or volume overload

Question 22

LV hypertrophy (thickening) from pressure overload; systolic wall stress

Answer 22

Concentric

Question 23

LV hypertrophy (dilation) from volume overload; diastolic wall stress

Answer 23

Eccentric

Question 24

Overtime: dilation as failing compensatory mechanism

Answer 24

law of Laplace

Question 25

engage more fibers what happens according to Frank-Starling curve

Answer 25

stronger contraction

Question 26

stretch too far of fibers what happens according to Frank-Starling curve

Answer 26

decrease in contraction

Question 27

sustained stimulation causes what to happen to beta receptors

Answer 27

sequestered into cell and degraded

Question 28

effect of beta receptor downregulation

Answer 28

decrease in inotropy, lusitropy, and chronotropy

Question 29

downregulation of beta receptors does what to NE

Answer 29

depletes NE stores overtime

Question 30

with increased stretch of atria and ventricles what is released and what is the effect

Answer 30

ANP and BNP are released; increased Na+ and water excretion

Question 31

effect of beta blockers

Answer 31

block NE/Epi from binding

Question 32

decrease HR, inotropy, chronotropy; cause vasodilation; decrease renin release

Answer 32

beta blockers

Question 33

main beta blocker used in HF

Answer 33

Carvedilol

Question 34

go to drugs to start treatment of HF

Answer 34

ACEIs/ARBs

Question 35

good drugs to use when treating HF symptoms

Answer 35

loop diuretics and K+ sparing diuretics

Question 36

new drug used for HF that targets RAAS and natriuretic peptide mechanism

Answer 36

Neprilysin inhibitor (ARB)—> ENTRESTO

SACUBITRIL