Treatment of Congestive Heart Failure

Question 1

heart contracts less forcefully and blood is pumped out (reduced ejection fraction)

Answer 1

systolic dysfunction

Question 2

heart is stiff and does not relax normally (reduced filling)

Answer 2

diastolic dysfunction

Question 3

• cardiac output high as the heart works hard to keep up with greatly increased body demands
• healthy heart exhausted by working too hard
• causes: hyperthyroidism, anemia, AV shunts, thiamine deficiency (beriberi)
• inotropic drug response is poor

Answer 3

high output heart failure

Question 4

• CO low b/c heart unable to keep up with tissue metabolic demands
• heart unable to pump enough blood to meet tissue needs
• causes: CAD, HTN, MI, arrhythymias, rheumatic heart disease
• inotropic drug response good

Answer 4

low output heart failure

Question 5

myocardial muscle mass and muscle wall thickness are increased to maintain cardiac performance, but can lead to ischemic changes

Answer 5

myocardial hypertrophy

Question 6

dilation and other slow structural changes in the heart, can include proliferation of connective tissue, of abnormal myocardial cells. mycocytes die at accelerated rate with remaining cells under even greater stress

Answer 6

remodeling

Question 7

in CHF _______ is elevated by increase in blood volume and venous tone

Answer 7

preload

Question 8

venodilators reduce _______ by dilating peripheral veins to retain more blood and keep blood away from the heart

Answer 8

preload

Question 9

diuretics and salt reduction reduce _______ by decreasing blood volume

Answer 9

preload

Question 10

in CHF ________ rises because of increases in sympathetic and renin-angiotensin activity which elevate peripheral resistance via arterial constriction

Answer 10

afterload

Question 11

arteriodilators reduce ________ by decreasing peripheral resistance

Answer 11

afterload

Question 12

inotropic drugs increase myocardial?

Answer 12

contractility

Question 13

B-blcokers reduce cardiac work by slowing?

Answer 13

heart rate

Question 14

reduce preload with which drugs?

Answer 14

diuretics, venodilators

Question 15

reduce afterload with which drugs?

Answer 15

arteriodilators

Question 16

reduce energy expenditure and reflex tachycardia with?

Answer 16

B-antagonists

Question 17

increase contractility with which drugs?

Answer 17

inotropics

Question 18

step 1 of CHF treatment: use ________ to reduce cardiac workload, if stable, patient with systolic dysfunction add _________

Answer 18

ACE inhibitor

B-blocker

Question 19

step 2 of CHF treatment: if persistent symptoms add ________ antagonist

Answer 19

aldosterone

Question 20

step 3 of CHF treatment: if persistent add ________, _______

-for AA patients add _________ instead b/c drugs that inhibit RAAS system are less effective

Answer 20

digoxin, ARB

hydralazine/isosorbide dinitrate

Question 21

ACEIs, ARBs, beta blockers, aldosterone receptor antagonists, and combined hydralazine-nitrate prolong?

Answer 21

life

Question 22

infuse IV in acute decompensated CHF as long as cerebral and renal perfusion can be maintained despite reduction in systemic BP

• balanced vasodilator, working on veins and arteries, reduced preload and afterload
• excessive hypotension side effect

Answer 22

sodium nitroprusside

Question 23

-relax arteriolar smooth muscles, produce vasodilation

Answer 23

calcium channel blockers (amlodipine, felodipine)

Question 24

• negative inotropic effect (worsen ventricular function, potentially harmful in CHF)
• long term treatment improves symptoms of CHF by slowing HR and contraction velocity to improve CO, exercise tolerance, and ventricular function

Answer 24

B-antagonists

Question 25

• reduce mortality in HF

- side effects: hyperkalemia, gynecomastia, renal insufficiency

Answer 25

aldosterone antagonists (spironolactone, eplerenone)

Question 26

• inotropic glycoside, treatment of CHF and atrial fibrillation
• increase cardiac contractility
• quinidine, amiodarone, captropril, verapemil, diltiazem and cyclosporine enhance toxicity

Answer 26

digoxin

Question 27

• inotropic and smooth muscle relaxing properties
• inactivate cAMP and cGMO
• increase contractility by increasing cAMP and inward calcium flux in the heart
• only for treatment in acute heart failure

Answer 27

PDE inhibitors