HF

Question 1

Factors leading to HF

Answer 1

Muscular dysfunction, Mechanical disorder, combo

Question 2

Risk factors of HF

Answer 2

HTN, Obesity, prediabetes/DM, ASCVD

Question 3

NYHA classes

Answer 3

I: no limitation of physical activity
II: comfortable at rest, but ordinarily activity results in symptoms
III: comfortable at rest, but less than ordinary activity results in symptoms
IV: unable to carry on any physical activity with symptoms

Question 4

Inotropic agents have not shown _____

Answer 4

improved survival survival in patients with HF

Question 5

Cardiac glycosides MOA

Answer 5

Inhibition of NA/K atpase so less Ca is removed from the cell resulting in increased intracellular Ca/ increased contractile force

Question 6

oral availability of cardiac glycosides

Answer 6

60-75%, half life 36-40H

Question 7

cardiac glycoside elimination

Answer 7

renal excretion 60%, hepatic metabolism 40%

Question 8

cardiac glycoside effects

Answer 8

decrease in compensatory sympathetic and renal responses
- increase contractility
- decreased end-systolic/ diastolic size
- increased CO
- increased renal perfusion

Question 9

cardiac glycoside monitoring

Answer 9

Serum digoxin levels
HF symptoms
renal funciton
electrolytes (hypercalcemia, hypokalemia, hypomagnesemia)

Question 10

digoxin toxicity signs and symptoms

Answer 10

cardiac: arrhythmias
noncardiac: anorexia, nausea, vomiting, abd pain, fatigue, weakness, dizziness, headache, neuralgia, confusion, delirium, psychosis
visual disturbances (halos, photophobia, color perception issues)

Question 11

digoxin toxicity serum level

Answer 11

> 2 ng/ml

Question 12

digoxin toxicity treatment

Answer 12

• stop digoxin
• oral/parenteral K supps
• lidocaine for ventricular arrhythmias
• propranolol for supraventricular arrhythmias
• atropine for AV block and bradycardia
• digoxin antibody if life threatening

Question 13

digoxin toxicity ECG

Answer 13

• Decreased QT interval (shortened ventricular action potential)
• Increased PR interval (decreased AV conduction velocity)
  ST segment depression

Question 14

Sympathomimetic Amines aka

Answer 14

Adrenergic Agonists (dopamine and dobutamine)

Question 15

Sympathomimetic Amines useful for:

Answer 15

Acute failure (diminished systolic function)

Question 16

sympathomimetic amines not appropriate for

Answer 16

Chronic failure (tolerance, lock of oral efficacy, arrhythmogenic effects)

Question 17

dobutamine vs dopamine

Answer 17

dobutamine preferred when there is need to improve low CO (no effect on alpha2-adrenergic receptors)

Question 18

Phosphodiesterase inhibitor name

Answer 18

Milrinone

Question 19

Phosphodiesterase Inhibitor MOA

Answer 19

Increase cAMP by inhibiting breakdown by phosphodiesterase = increase intracellular calcium = vasodilation

Question 20

Drug reserved for severe decompensated heart failure

Answer 20

Milrinone

Question 21

Drug shown to reduce risk of death and the combined risk of death or hospitalization in patients with HFrEF

Answer 21

Beta blockers

Question 22

Shown to be effective in reducing risk of death in pts with HFrEF:

Answer 22

Bisoprolol, metoprolol (succinate), carvedilol

Question 23

BB should be used in stable patients with:

Answer 23

no inotropic support
(negative intropic effect = symptomatic worsening/ acute decompensation)

Question 24

BB monitoring

Answer 24

bradycardia, hypotension, fatigue, fluid retention/ worsening symptoms

Question 25

Which drug class for the following? - Prevent death - Improved survival by 20-30% - slows progression - Reduced hospitalization with current or prior symptoms

Answer 25

ACE/ARB

Question 26

ACE/ARB monitoring

Answer 26

- Hypotension - Hyperkalemia - Dry cough - Angioedema - Pregnancy

Question 27

_____ is recommended to reduce morbidity and mortality

Answer 27

ARNi (Valsartan + Sacubitril)

Question 28

ARNi MOA

Answer 28

Inhibiting neprilysin reduces breakdown of beneficial peptides (i.e. natriuretic peptides)

Question 29

ARNi should not be co-administered with______

Answer 29

ACEi or within 36 hours of ACE because of risk of angioedema

Question 30

Mediates major effects of RAAS (myocardial remodeling and fibrosis, sodium retention and K loss at distal tubules

Answer 30

Aldosterone Antagonist (K sparing diuretics)

Question 31

Most effective for moderate to severe heart failure with dyspnea, and fluid overload

Answer 31

Diuretic therapy

Question 32

_____ are preferred over thiazide & have a rapid onset and relatively short duration of action

Answer 32

Loop diuretics

Question 33

For patients with HF and congestive symptoms, addition of _______ to a loop should be reserved for patients who do not respond to moderate-or high-dose loop diuretics to minimize electrolyte abnormalities

Answer 33

thiazide diuretic

Question 34

Diuretic Therapy Monitoring Considerations

Answer 34

- Volume depletion - Prerenal azotemia - Hypotension - Hypokalemia (particularly with accompanying digoxin therapy) - less common: skin rashes, GI distress, ototoxicity (loop)

Question 35

Substantially reduce risk of CV death and hospitalization for HF for pts with reduced LVEF, with or without diabetes

Answer 35

SGLT2 inhibitors

Question 36

_________ and _______ reduce cardiovascular death and heart failure hospitalization, and they have been approved for treating heart failure with reduced LVEF irrespective of the presence of type 2 diabetes

Answer 36

Dapagliflozin / empagliflozin

Question 37

SGLT2 inhibitors also reduce ______

Answer 37

kidney disease progression

Question 38

SGLT2 inhibitor monitoring

Answer 38

- genetic mycotic infections - UTI - polyuria - risk of hypotension and hypovolemia due to osmotic diuresis - euglycemic ketoacidosis

Question 39

For patients self-identified as African American with NYHA class III/IV HFrEF who are receiving optimal medical therapy, the combination of _____ and ______ is recommended to improve symptoms and reduce morbidity and mortality

Answer 39

hydralazine/ isosorbide dinitrate

Question 40

Nitrites

Answer 40

Intravenous vasodilators: sodium nitroprusside or nitroglycerin

Question 41

Nitrite use

Answer 41

Acute/ Severely decompensate chronic heart failure, especially with HTN or MI

Question 42

________ have no sustained effect in pts with heart failure and should not be used for this indication

Answer 42

Transdermal nitroglycerin patches