HF Flashcards
What is Heart Failure (HF)?
HF is a complex clinical syndrome caused by any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood.
HF can lead to inadequate cardiac output, especially during increased metabolic demand.
What is the 5-year mortality rate for Heart Failure?
50%.
This statistic underscores the severity of the condition.
What are the two main types of Heart Failure based on ejection fraction?
- Systolic HF (HFrEF)
- Diastolic HF (HFpEF)
HFrEF is characterized by an ejection fraction (EF) < 40%, while HFpEF has an EF > 50%.
What causes Systolic Heart Failure (HFrEF)?
Reduction in the mechanical pumping force with resultant decrease in ejection fraction (EF < 40%).
HFrEF is the most common type of HF.
What is Diastolic Heart Failure (HFpEF)?
Loss of adequate filling of the ventricle caused by abnormal ventricular relaxation (EF > 50%).
Both systolic and diastolic HF often coexist, particularly in patients with CAD.
What are the common symptoms of Heart Failure?
- Fatigue
- Decreased exercise tolerance
- Shortness of breath or Dyspnea
- Peripheral and pulmonary edema
- Cardiomegaly
Symptoms are primarily due to congestion and organ-system dysfunction from inadequate cardiac output.
What is a non-pharmacological management strategy for Heart Failure?
- Treatment of underlying causes (angioplasty, bypass surgery)
- Control of modifiable risk factors (Bp, DM, LDL, TG)
- Restricting intake of salt
- Regular modest exercise
- Heart transplantation
These strategies aim to improve patient outcomes and manage symptoms.
Which classes of drugs are effective in stable Heart Failure?
- ACE inhibitors
- ARBs
- Certain β-blockers
- MRAs
- Diuretics
- Cardiac glycosides
- Hydralazine-Isosorbide dinitrate
- Ivabradine
- Sacubitril/valsartan
- SGLT inhibitors (Dapagliflozin & Empagliflozin)
These drugs have been shown to improve outcomes in patients with HF.
True or False: Diuretics and Digoxin prolong life in patients with Heart Failure.
False.
While valuable for symptomatic relief, they do not prolong life.
What is the recommended treatment for patients with HFrEF and an EF ≤40%?
ACE inhibitors and β-blockers should be administered to reduce the risk of hospitalization and premature death.
This recommendation is based on clinical guidelines.
Fill in the blank: An MRA is recommended for all patients with persisting symptoms (NYHA class II–IV) and an EF ________.
≤35%.
This recommendation helps reduce the risk of HF hospitalization and premature death.
What is the mechanism of action for Sacubitril?
Prodrug metabolized to an active metabolite that inhibits neprilysin, increasing natriuretic peptides, bradykinin, and substance P.
This leads to natriuretic, vasodilatory, and anti-proliferative effects.
Who should receive Ivabradine treatment?
Patients with symptomatic HF (NYHA class II and III), stable, chronic HFrEF (LVEF of 35% or less) who are receiving evidence-based therapies, including a β-blocker at maximum tolerated dose.
This is a class IIa recommendation.
What is the recommended approach for managing acute decompensated Heart Failure?
- Diuretics (Loop diuretics +/- Thiazides)
- Venodilators (Nitroglycerin)
- Arterio/venodilators (Sodium Nitroprusside)
- Inotropes (Dobutamine Vs. Milrinone)
- Inotrope + vasopressor (Dopamine)
Management strategies depend on the patient’s blood pressure and clinical status.
What should be avoided in patients with Heart Failure?
- NSAIDs
- Corticosteroids
- Class I and III antiarrhythmic agents (except amiodarone & dofetilide)
- Certain CCBs (except amlodipine and felodipine)
- Thiazolidinediones
- Metformin
- Amphetamines
- Cilostazol
- Itraconazole
- Pregabalin
These medications can exacerbate heart failure symptoms or have negative effects.
What are the class I recommendations for pharmacologic therapy of HFpEF?
- SBP and DBP should be well controlled
- Diuretics should be used for symptom relief (volume overload)
These recommendations help manage symptoms and improve quality of life.
What is the combination of medications used for treating acute heart failure (HF) inotrope diuretic?
Inotrope Diuretic + Inotrope
Inotropes are medications that improve heart muscle contractility.
What is the role of an arteriodilator in the treatment of heart failure?
Arteriodilator
Arteriodilators are used to lower blood pressure.
What determines the choice of drug in subsets 3 and 4 for heart failure treatment?
Blood pressure
The choice is based on whether blood pressure is high, normal, or low.
If a patient has high blood pressure, which type of medication should be administered?
Arteriodilator
Arteriodilators help manage high blood pressure in heart failure cases.
If blood pressure is normal to low, what type of medication is preferred?
Inotropes
Inotropes are used when blood pressure is normal to low.
In the case of low blood pressure and low heart rate, which medication should be considered?
Dopamine
Dopamine can help increase heart rate and blood pressure.
What was the primary complaint of the 72-year-old man admitted for HF decompensation?
Progressively increased dyspnea when walking and orthopnea
Orthopnea refers to difficulty breathing when lying flat.
What treatment is best for the 72-year-old man with acute decompensated heart failure?
C. Furosemide 120 mg intravenously twice daily
Furosemide is a diuretic that helps reduce fluid overload.
What are the vital signs of the 60-year-old woman with heart failure (HFrEF)?
BP 125/70 mm Hg, HR 92 beats/minute
These values indicate her blood pressure and heart rate status.
After initiating an IV diuretic, which agent is best to rapidly treat the woman’s pulmonary symptoms?
B. Milrinone
Milrinone is an inotropic agent used for acute heart failure management.
What notable change occurred in the urinary output of the previous patient after treatment?
Increased by 2 L overnight
This indicates a positive response to the diuretic therapy.
What was the patient’s condition by day 5 after treatment?
Urinary output diminished and SCr rose to 4.3 mg/dL
A rise in serum creatinine (SCr) suggests worsening renal function.
What should be administered to the patient who has shown diminished urinary output and confusion?
B. Dobutamine 10 mcg/kg/minute
Dobutamine can improve cardiac output in patients with worsening heart failure.
True or False: Sodium nitroprusside is used to lower blood pressure in acute heart failure management.
True
Sodium nitroprusside is an arteriodilator effective for managing high blood pressure.
Fill in the blank: Inotrope + Diuretic + _______ is used in acute heart failure treatment.
Arteriodilator
This combination can help manage various symptoms of heart failure.
