Management of Heart Disease and Heart Failure

Question 1

what main things can confirm congestive heart failure?

Answer 1

clinical signs compatible with
radiographic evidence of CHF
elevated NT-proBNP
jugular distention with ascites

Question 2

what specific outcomes of interest do we use in veterinary medicine when choosing drugs?

Answer 2

prolonged survival
improved quality of life

Question 3

what is valsartan?

Answer 3

angiotensin receptor blocker

Question 4

what is a neprilyin inhibitor?

Answer 4

sacubitril

Question 5

what is neprilysin?

Answer 5

membrane bound endopeptidase

Question 6

what does a neprilysin inhibitor do when given alone?

Answer 6

increases vasodilation and vasoconstriction

Question 7

what is sodium glucose co-transporter-2?

Answer 7

a main enzyme for reabsorption of filtered glucose from the renal tubules

Question 8

what are the four most important drugs for CHF?

Answer 8

furosemide or torsemide
pimobendan
ACE inhibitors
spironolactone

Question 9

what is furosemide indicated for?

Answer 9

cardiogenic edema: pulmonary edema, pleural effusion, ascites

Question 10

where does furosemide work?

Answer 10

ascending limb loop of henle

Question 11

what does furosemide do?

Answer 11

blocks resorption chloride and electrolytes: impairs Na/K/2Cl cotransporter
water follows electrolytes

Question 12

what are the side effects of furosemide?

Answer 12

dehydration
azotemia
hypokalemia
hypochloremia
hyponatremia
metabolic alkalosis
vomiting, pancreatitis, blood dyscrasia
deafness with rapid IV injections

Question 13

what is pimobendan?

Answer 13

calcium sensitizer: inotropic
phosphodiesterase III inhibitor: vasodilator and inotropic

Question 14

what is pimobendan approved for?

Answer 14

CHF due to MMVD
CHF due to DCM

Question 15

what are the side effects of pimobendan?

Answer 15

uncommon:
diarrhea
tachycardia or arrhythmia
increased excitability

Question 16

when do we use pimobendan in cats?

Answer 16

with CHF and no left ventricular outflow tract obstruction

Question 17

what are the effects of digitalis glycosides?

Answer 17

positive inotrope
vagomimetic effect
reduced sympathetic output
improved baroreceptor function

Question 18

how is digoxin eliminated?

Answer 18

renal

Question 19

what are the electrocardiographic changes with digitalis glycosides?

Answer 19

slowed heart rate
prolonged P-R interval or AV block
shorted QT interval
ST segment changes
junctional or ventricular arrhythmias

Question 20

what are the main clinical uses of digoxin?

Answer 20

treat supraventricular arrhythmias
treat recurrent syncope in dogs with MMVD
treat congestive heart failure

Question 21

what are the signs of digitalis intoxication?

Answer 21

anorexia, lethargy, depression
vomiting and diarrhea
cardiac arrhythmias

Question 22

what are the class IV antiarrhythmic drugs?

Answer 22

diltiazem
amlodipine

Question 23

what are the current recommendation for treatment of stage C heart failure?

Answer 23

furosemide or torsemide as needed
pimobendan
angiotensin-converting enzyme inhibitor
spironolactone

Question 24

what is an ACE inhibitor helpful for with CHF?

Answer 24

improves clinical signs
improved survival or time until worsening CHF

Question 25

what is nitroglycerin?

Answer 25

venous vasodilator also dilates coronary arteries

Question 26

what is amlodipine?

Answer 26

calcium channel blocker

Question 27

what is sodium nitroprusside?

Answer 27

balanced vasodilator

Question 28

what are the side effects of sodium nitroprusside?

Answer 28

hypotension GI side effects cyanide intoxication

Question 29

what are some thiazide diuretics?

Answer 29

hydrochlorothiazide chlorothiazide

Question 30

what are the effects of epinephrine?

Answer 30

positive inotropic effect positive chronotropic effect significant arrhythmogenesis dramatic rise in blood pressure

Question 31

what are the effects of norepinephrine?

Answer 31

positive inotropic effect positive chronotropic effect significant arrhythmogenesis rise in blood pressure

Question 32

what is isoproterenol?

Answer 32

positive inotrope

Question 33

should you give beta blockers if there are active congestion signs with CHF?

Answer 33

no

Question 34

what does chronic sympathetic activation in CHF lead to?

Answer 34

arrhythmogenic increase heart rate vasoconstriction stimulate renin release cardiomyotoxic promote myocardial fibrosis/cardiac remodeling

Question 35

what does sympathetic blockade in CHF do?

Answer 35

improves left ventricle function (ejection fraction) blunts cardiac remodeling improves quality of life (human) prolongs survival and event-free survival (human)

Question 36

what does an angiotensin receptor blocker and neprilysin inhibitor do?

Answer 36

vasodilation, Na excretion (ANP, BNP, urodilation) block negative effects of angiotensin II

Question 37

what are some SGLT2 inhibitors?

Answer 37

empagliflozin bexagliflozin velagliflozin

Question 38

what does it mean that furosemide is a high ceiling diuretic?

Answer 38

wide dose range

Question 39

what is the dose of furosemide for mild CHF?

Answer 39

2 mg/kg

Question 40

what is the dose of furosemide for advanced CHF?

Answer 40

up to 4 mg/kg

Question 41

what do retrospective studies on pimobendan in cats suggest?

Answer 41

cats tolerate pimobendan well doses same in dogs and cats maybe live longer from CHF

Question 42

what are digitalis glycosides derived from?

Answer 42

foxglove plant

Question 43

how is digitoxin eliminated?

Answer 43

liver

Question 44

how is digoxin dosed?

Answer 44

conservatively

Question 45

what can predispose an animal to digitalis intoxication?

Answer 45

renal insufficiency hypokalemia hypomagnesemia reduced skeletal mass advanced age dosing without consideration of ascites other drug interactions

Question 46

what can diltiazem be used to treat?

Answer 46

supraventricular tachycardia atrial fibrillation hypertrophic cardiomyopathy coronary vasodilation

Question 47

what are the side effects of class IV antiarrhythmics?

Answer 47

excessive negative chronotropism negative inotropism excessive vasodilation

Question 48

why do we use ACE inhibitors with systemic hypertension?

Answer 48

reduces blood pressure reduces hypertensive events

Question 49

what are the possible side effects of ACE inhibitors?

Answer 49

hypotension azotemia renal failure GI side effects cough

Question 50

what do spironolactone and eplerenone do?

Answer 50

aldosterone antagonists: conserve potassium, mild diuretic effect, restores baroreceptor function toward normal

Question 51

which loop diuretic has potassium sparing effects?

Answer 51

torsemide: mild

Question 52

what do venous vasodilators do?

Answer 52

reduce preload

Question 53

what do arterial vasodilators do?

Answer 53

reduce afterload: increase LV forward flow and hopefully less mitral regurgitation

Question 54

what do thiazide diuretics do?

Answer 54

inhibit sodium and chloride absorption in the distal tubule weaker diuretic

Question 55

what are the downsides to beta-blockers?

Answer 55

acutely negative inotropes benefits take 2-3 months to accrue QOL and euthanasia wildcard

Question 56

what does neprilysin do?

Answer 56

cleaves natriuretic peptides breaks down angiotensin II, endothelin

Question 57

when should you use furosemide as a CRI?

Answer 57

refractory emergency pulmonary edema

Question 58

what is the therapeutic range of digoxin concentrations?

Answer 58

0.8-2 ng/ml toxic: >2.5 ng/ml

Question 59

what does angiotensin II cause?

Answer 59

vasoconstriction release of aldosterone increases thirst stimulate ADH release sympathetic stimulation

Question 60

how can sodium nitroprusside be used?

Answer 60

as CRI for severe pulmonary edema