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Cardio Quiz Bowl > Management Of Heart Failure > Flashcards

Management Of Heart Failure Flashcards

1
Q

Therapeutic targets for HFpEF

A

Control congestion
Stabilization of heart rate and BP
Improve exercise tolerance

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2
Q

Lusitropic agents act by?

A

Enhancing the relaxation of cardiac myocytes. Examples

CCB, Beta blockers

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3
Q

This study showed reduction in hospitalization but no effect on all- cause mortality in HFpEF patients by candesartan

A

CHARM

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4
Q

Trial showed no difference in meaningful endpoints in patients treated with irbesartan?

A

I - PRESERVE

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5
Q

This study showed no role for Digoxin in patients with HFpEF

A

DIG trial

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6
Q

This trial concluded that there’s no role for all- cause mortality and cardiovascular mortality in patients being treated with nebivolol?

A

SENIORS

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7
Q

This trial showed that PDE5 inhibitors improved filling pressure and RV function but no role in improving FC, QOL, or other clinical surrogate parameters using sildenafil?

A

RELAX trial

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8
Q

This trial demonstrated no improvement in the primary
composite end-point, but did show a secondary signal of benefit on HF
hospitalizations, counterbalanced, however, by an increase in adverse
effects, particularly hyperkalemia. Using aldosterone antagonists?

A

TOPCAT

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9
Q

This trial showed that spironolactone improved echocardiographic indices of diastolic dysfunction but failed
to improve exercise capacity, symptoms, or quality-of-life measures.

A

ALDO-DHF

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10
Q

a heterogeneous clinical syndrome most often resulting in need for hospitalization due to confluence of interrelated abnormalities of decreased cardiac performance, renal dysfunction, and altera-
tions in vascular compliance.

A

ADHF (acute decompensated heart failure)

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11
Q

ADHF is associated with a short-term mortality of how many percent?

Long term mortality?

A

Short term 5-8%

Long term at one year 20%

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12
Q

A herbal form of ephedrine

A

Ma huang

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13
Q

Parameters associated with worse outcomes in ADHF?

A

BUN >43mg/DL (x .357 to convert to mmol/L)
SBP < 115 mmHg
Creatinine >2.75mg/dL (x88.4 to convert to mmol/L)
Elevetated trop I

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14
Q

reflect the interplay between abnormalities of

heart and kidney function, with deteriorating function of one organ while therapy is administered to preserve the other.

A

Cardiorenal syndrome

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15
Q

How many percent of ADHF patients have abnormal renal function at baseline?

A

30%

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16
Q

This investigation argues against using UF(ultra filtration) as a primary strategy in patients with ADHF
who are nonetheless responsive to diuretics.

A

CARRESS-HF

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17
Q

this trial showed that Nesiritide was not associated with an
increase or a decrease in the rates of death and rehospitalization and
had a clinically insignificant benefit on dyspnea. Renal function did not worsen but increased rates of hypotension were noted.

A

ASCEND-HF

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18
Q

This trial showed that Serelaxin improved dyspnea, reduced signs and symptoms of congestion, and was associated with less early worsening of
HF.

A

RELAX - AHF

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19
Q

This inotropic provides the advantage of sparing Beta 1 stimulation thus is good for patients taking beta blockers.

A

Milrinone

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20
Q

trial compared levosimendan against traditional noninotropic therapy and found a modest
improvement in symptoms with worsened short-term mortality and
ventricular arrhythmias.

A

REVIVE II

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21
Q

compared levosimendan with dobutamine, and despite an initial reduction in circulating B-type natriuretic peptide levels in the levosimendan group compared with patients in the dobutamine group,
this drug did not reduce all-cause mortality at 180 days or affect any secondary clinical outcomes.

A

SURVIVE

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22
Q

This drug is a calcium sensitizer that
provides inotropic activity, but also possesses phosphodiesterase-3
inhibition properties that are vasodilators in action

A

Levosimendan

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23
Q

This drug is a selective myosin activator prolongs ejection period and increases fractional shortening?

A

Omecamtiv mecarbil

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24
Q

Trial that studied on the effect of selective vasopressin 2 antagonist?

A

EVEREST

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25
Q

Study on Rolofylline for patients hospitalized with ADHF

A

PROTECT

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26
Q

Usual dose of dobutamine

A

2-20 ug/kg/min

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27
Q

Usual dose of Milrinone

Levosimendan

Omecamtiv mecarbil

A

Mil 0.375 -0.75 ug/kg/min

Levosi - 0.1 ug/kg/min range 0.05 - 0.2

Ome - N/A

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28
Q

Usual dose of

NTG

Nesiritide

Nitropruside

Serelaxin

A

NTG 10-20 ug/min

Nesi - bolus 2 ug/kg infusion 0.01 ug/kg/min

Nitrops - 0.3 ug/kg/min upto 5 ug

Serelax N/A

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29
Q

Furosemide usual dose?

Torsemide

Bumetanide

A

20-240 mg daily

Torse 10-100 mg daily

Bumet 0.5-5 mg daily

30
Q

Cornerstone of HFrEF therapy?

A

Beta blockers and ACEI’s

31
Q

Percent reduction of ACEI therapy in mortality?

Combination endpoint mortality and hospitalization?

A

Mortality 23%

Combined endpoint 35%

32
Q

Additional percent mortality reduction by beta blockers?

A

35%

33
Q

Benefits of ACEI and beta blockers extend to what NYHA calss?

A

Class IIIb to IV

34
Q

True or false: ACEI exert their beneficial effect in HF as a class.

A

True

35
Q

Beta blockers with benefit for HFrEF?

A

Carvedilol
Bisoprolol
Metoprolol succinate

36
Q

This trial stated that it does not matter if patient is started first on ACEI or BB using Bisoprolol?

A

CIBIS III

37
Q

In the absence of s/sx of hypotension pharmacotherapy may be uptitrated every?

A

Every 2 weeks

38
Q

Aldosterone antagonism is associated with reduction in mortality in what NYHA stages of HFrEF?

A

Class II to IV

39
Q

What agent blunts the neurohormonla escape phenomenon with long term use of ACEI?

A

ARBs

40
Q

This trial suggested that addition of valsartan in patients already receiving
treatment with ACEIs and beta blockers was associated with a trend
toward worse outcomes?

A

Val - HeFT trial

41
Q

This trial tested a direct renin inhibitor, aliskiren,
in addition to other heart failure medications, within a week after
discharge from a hospitalization for decompensated HFrEF.

A

ASTRONAUT

42
Q

This agent inhibits sodium If channels to slow dwon HR without negative inotropic effect?

A

Ivabradine

43
Q

This trial showed that Ivabradine reduced hospitalizations and
the combined endpoint of cardiovascular-related death and heart
failure hospitalization.

A

SHIFT

44
Q

This drug is a mild inotropic, attenuates baroreceptor activity and is sympathoinibitory?

A

Digoxin

45
Q

Drug Initiation dose. Target dose
Lisinopril

Enalaparil

Captopril

Trandolapril

A

Initiation Target
Lisi 2.5-5qd. 20-35 qd

Enalapril 2.5 bid. 10-20 bid

Captopril 6.25 tid. 50 tid

Trandolapril 0.5 to 1 qd. 4 qd

46
Q

Drug. Initiation. Target

Losartan

Valsartan

Candesartan

A

Initiation. Trget

Losartan 50qd. 150qd

Valsartan. 40. Bid 160 bid

Candesartan 4-8 qd. 32 qd

47
Q

Drug Initiation. Target

Eplerenone.

Spironolactone

A

Drug initiation. Target

Eplerenone. 25qd. 50qd

Spironolactone. 12.5 -25.qd 25 - 50qd

48
Q

Drug. Initiation. Target

Metoprolo succ

Carvedilol

Bisoprolol

A

Drug intitation. Target

Metoprolol 12.5. - 25qd 200qd

Carvedilol 3.125 bid. 25 - 50 bid

Bisoprolol 1.25qd. 10 qd

49
Q

Hydralazine plus isdn

A

Initiation

37.5/20 tid

Target.

75/40. Tid

Qid for fixed dose

50
Q

Study that tested nonsecific immunomodulation in heart failure?

A

ACCLAIM-HF

51
Q

Trials that tested low-dose rosuvastatin in patients
with HFrEF and demonstrated no improvement in aggregate clinical
outcomes.

A

CORONA

GISSI- HF

52
Q

This trial showed that Among patients with reduced LVEF who were in sinus rhythm, there was no significant overall difference in the primary outcome between treatment with
warfarin and treatment with aspirin.

A

WARCEF

53
Q

EPA (eicosapentanoic acid) levels in HF patients should be? High or low?

A

High

54
Q

Reversible HF has been described as a consequence of micronutrient deficiency such as?

A

Thiamine and selenium

55
Q

This trial evaluated the effect of external counterpulsation in patients with CHF?

A

PEECH

56
Q

This study investigated short-term
(3-month) and long-term (12-month) effects of a supervised exercise
training program in patients with moderate HFrEF. Exercise was
safe, improved patients’ sense of well-being, and correlated with a
trend toward mortality reduction.

A

HF-ACTION

57
Q

Mechanisms of Anemia in patients with HF?

A

iron deficiency,
dysregulation of iron
metabolism, and
occult gastrointestinal bleeding.

58
Q

demonstrated that treatment with darbepoetin alfa did not

improve clinical outcomes in patients with systolic heart failure

A

RED-HF

59
Q

showed that sertraline was safe, but did not
provide greater reduction in depression or improve cardiovascular
status among patients with heart failure and depression compared with
nurse-driven multidisciplinary management.

A

SADHART- CHF

60
Q

Antiarrhythmic drug in HF pateints should be restricted to?

A

Amiodarone and dofetilide

61
Q

studied the effects of the novel antiarrhythmic agent
dronedarone and found an increased mortality due to worsening heart
failure.

A

ANDROMEDA

62
Q

Single most important association of extent of dyssynchrony?

A

Widened QRS in the presence of LBBB

63
Q

first study to demonstrate
a reduction in all-cause mortality with CRT(cardiac resynchronization therapy) placement in patients
with HFrEF on optimal therapy with continued moderate-to-severe
residual symptoms of NYHA class III or IV heart failure

A

CARE-HF

64
Q

clinical trials have demonstrated disease-modifying properties of CRT
in even minimally symptomatic patients with HFrEF

A

RAFT

MADIT-CRT

65
Q

Most benefit with CRT is seen whne QRS is how many ms?

A

> 149 ms wtih a LBBB pattern

66
Q

Mode of death in approximately 1/2 of patients with HF?

A

SCD (sudden cardiac death)

67
Q

Two most important factors to consider to administer ICD (implantable cardioverter-defibrilator)

A
  1. LVD despite optimal therapy with = 35% EF

2. Undelying etiologyt (post MI)

68
Q

Type of myocardium that has abnormal function but maintained cellular function

A

Hybernating myocardium

69
Q

Trial that evaluated the effect of CABG on HF patients

A

STITCH

70
Q

technique character-
ized by infarct exclusion to remodel the left ventricle by reshaping it
surgically in patients with ischemic cardiomyopathy and dominant
anterior left ventricular dysfunction,

A

Surgical ventricular restoration

71
Q

Type of MR where there is annular dilatation and leaflet noncoaptation in the setting of anatomically normal papillary muscles, chordal structures, and valve leaflets.

A

Functional MR

72
Q

Most heart - failure related readmissions tend to occur within how many weeks?

A

Wtihin 2 weeks from discharge

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