Sawicki Ischemia,Heart Failure (1)

Question 1

What is coronary revascularization?

Answer 1

A critical intervention for patients experiencing inadequate relief from angina through medication.

Question 2

When is coronary revascularization indicated?

Answer 2

If the patient’s symptoms of angina do not respond adequately to antianginal drug therapy, unacceptable side effects of medications occur, or the patient has high-risk coronary disease.

Question 3

What are the two techniques used for mechanical revascularization?

Answer 3

• Percutaneous coronary intervention (PCI)
• Coronary artery bypass graft (CABG) surgery

Question 4

Describe the process of placing a coronary artery stent.

Answer 4

A stent is advanced into the coronary stenosis on a balloon catheter, the balloon is inflated to expand the stent, then the balloon is deflated and removed, leaving the stent in place.

Question 5

What is cardiac ischemia?

Answer 5

An imbalance between myocardial oxygen supply and demand.

Question 6

What are the determinants of myocardial oxygen supply?

Answer 6

• Oxygen content of the blood
• Coronary blood flow

Question 7

What key regulators affect myocardial oxygen demand?

Answer 7

• Heart rate
• Contractility
• Myocardial wall stress

Question 8

What is angina pectoris?

Answer 8

The most frequent symptom of intermittent myocardial ischemia.

Question 9

What pharmacologic agents are used in the standard therapy for chronic angina?

Answer 9

• Beta-blockers
• Nitrates
• Calcium channel antagonists
• Aspirin
• Statins
• ACE inhibitors

Question 10

What are modifiable risk factors for atherosclerosis?

Answer 10

• Dyslipidemia
• Smoking
• Hypertension
• Diabetes

Question 11

How does CABG surgery benefit high-risk groups?

Answer 11

It confers improved survival rates for certain high-risk groups.

Question 12

What characterizes heart failure?

Answer 12

Inability of the heart to pump blood forward at a sufficient rate to meet metabolic demands or only at abnormally high filling pressures.

Question 13

List common symptoms of heart failure.

Answer 13

• Fatigue
• Shortness of breath
• Volume overload

Question 14

What are the major determinants of stroke volume?

Answer 14

• Preload
• Afterload
• Myocardial contractility

Question 15

What is the formula for cardiac output (CO)?

Answer 15

CO = Stroke Volume (SV) x Heart Rate (HR)

Question 16

Define preload.

Answer 16

The ventricular wall tension at the end of diastole, approximated by end-diastolic volume.

Question 17

Define afterload.

Answer 17

The ventricular wall tension during contraction, approximated by systolic ventricular (or arterial) pressure.

Question 18

What is contractility?

Answer 18

Property of heart muscle accounting for changes in contraction strength, independent of preload or afterload.

Question 19

What is stroke volume (SV)?

Answer 19

Volume of blood ejected from the ventricle during systole.

Question 20

What is ejection fraction (EF)?

Answer 20

The fraction of end-diastolic volume ejected during each systolic contraction (normal range = 55%-75%).

Question 21

What causes left-sided heart failure?

Answer 21

• Impaired ventricular contractility
• Increased afterload
• Impaired ventricular relaxation and filling

Question 22

What are the two categories of heart failure based on left ventricular ejection fraction?

Answer 22

• Heart failure with reduced EF
• Heart failure with preserved EF

Question 23

What is the role of compensatory neurohormonal stimulation in heart failure?

Answer 23

Increases cardiac output and blood pressure but can lead to adverse effects like increased afterload and fluid retention.

Question 24

What triggers the adrenergic nervous system response in heart failure?

Answer 24

The fall in cardiac output sensed by baroreceptors in the carotid sinus and aortic arch.

Question 25

What are the immediate consequences of sympathetic activation in heart failure?

Answer 25

* Increase in heart rate * Augmentation of ventricular contractility * Vasoconstriction

Question 26

What stimulates renin secretion in heart failure?

Answer 26

* Decreased renal artery perfusion pressure * Decreased salt delivery to the macula densa * Stimulation of juxtaglomerular beta-receptors

Question 27

What is the role of antidiuretic hormone (ADH) in heart failure?

Answer 27

Promotes water retention, increasing intravascular volume and left ventricular preload but can lead to harmful effects over time.

Question 28

What are natriuretic peptides?

Answer 28

Beneficial hormones secreted in heart failure in response to increased intracardiac pressures.

Question 29

What are the two types of natriuretic peptides?

Answer 29

* Atrial natriuretic peptide (ANP) * B-type natriuretic peptide (BNP)

Question 30

How does ADH activation affect heart failure symptoms?

Answer 30

Initially beneficial for fluid retention but can worsen symptoms and heart function if prolonged.

Question 31

What are some conditions that can cause right-sided heart failure?

Answer 31

* Left-sided heart failure * Pulmonic valve stenosis * Right ventricular infarction * Pulmonary parenchymal diseases * Chronic obstructive pulmonary disease * Pulmonary embolism

Question 32

What are the two types of natriuretic peptides discussed?

Answer 32

Atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) ## Footnote ANP is released in response to atrial distention, while BNP is produced in response to ventricular myocardium hemodynamic stress.

Question 33

What triggers the release of Atrial natriuretic peptide (ANP)?

Answer 33

Atrial distention ## Footnote ANP is stored in atrial cells and released when the atria are stretched.

Question 34

Under what condition is B-type natriuretic peptide (BNP) detected?

Answer 34

When ventricular myocardium is subjected to hemodynamic stress ## Footnote BNP is not detected in normal hearts.

Question 35

What actions do natriuretic peptides have in heart failure?

Answer 35

They result in: * Secretion of sodium and water * Vasodilation * Inhibition of renin secretion * Antagonism of AII effects on aldosterone and vasopressin levels ## Footnote These actions are largely opposite to those of other hormone systems activated in heart failure.

Question 36

What is endothelin-1 and its role in heart failure?

Answer 36

A potent vasoconstrictor derived from endothelial cells ## Footnote Plasma concentration of endothelin-1 correlates with disease severity and adverse outcomes in heart failure.

Question 37

What effect do drugs designed to inhibit endothelin receptors have?

Answer 37

They improve left ventricular (LV) function ## Footnote Targeting endothelin receptors can have a positive impact on heart failure management.

Question 38

True or False: Natriuretic peptides are harmful hormones in the context of heart failure.

Answer 38

False ## Footnote Natriuretic peptides are beneficial hormones that counteract harmful effects of other neurohormonal systems.

Question 39

Fill in the blank: The clinical significance of measuring natriuretic peptides can enhance understanding of _______.

Answer 39

heart failure diagnostics and management ## Footnote Monitoring these peptides is important for assessing heart failure.