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CVR Biweekly 3 > Treatment of Heart Failure-Al-Mehdi > Flashcards

Treatment of Heart Failure-Al-Mehdi Flashcards

1
Q

what must be present for diagnosis of HF

A

increase in LA pressure (increase in PCWP)

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2
Q

HF mortality rate=

A

50% w/in 5 years of diagnosis

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3
Q

ischemia-MI
HTN, stenosis
Arrythmias

A

cause HFrEF

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4
Q

LV hypertrophy
HTN
myocardial fibrosis

A

cause HFpEF

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5
Q

binds ______ in hypothalamus that then makes POMC (and alpha-MSH)

A

leptin; arcuate nucleus

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6
Q

alpha-MSH binds ____ receptor on PVN neurons that inhibit______ causing RVLM stimulation and sympathetic activation

A

MC4 receptors; NTS receptors

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7
Q

what leads to LV workload increasing and maladaptive remodeling and hypertrophy of LV

A

renin increasing Ang II leading to vasoconstriction and increase in afterload

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8
Q

myocyte hypertrophy/necrosis and perivascular and interstitial fibrosis

A

concentric remodeling

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9
Q

this leads to ventricular enlargement and systolic/diastolic dysfunction and changes in wall stress

A

concentric remodeling

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10
Q

1st hit after concentric remodeling where you can still preserve EF

A

concentric LVH

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11
Q

2nd hit to the heart from MI/myocarditis can lead to what

A

eccentric LVH dilatation

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12
Q

force holding aortic valve closed

A

diastolic pressure

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13
Q

what is the same in HFpEF and HFrEF

A

LVEDP

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14
Q

pathognomonic sign of HF

A

orthopnea

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15
Q

most common sign of HF

A

Dyspnea

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16
Q

what causes dyspnea in HF

A

interstitial pulmonary edema

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17
Q

another sign of HF in lower extremities

A

pitting edema

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18
Q

what causes increase in PCWP in HF

A

congestion (pulmonary edema)

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19
Q

muscle mass loss

A

cachexia

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20
Q

what causes cachexia and can lead to anorexia

A

TNFalpha increase in CHF

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21
Q

what cytokines also increase in CHF

A

IL-6 and CRP

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22
Q

lab that is highly pathognomonic of cardiovascular disease

A

NT-proBNP

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23
Q

biomarker in CVD for myocyte necrosis

A

Troponin Ic

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24
Q

biomarker in CVD for inflammation

A

CRP, IL-6

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25
Q

biomarker in CVD for accelerated atherosclerosis

A

LDL
HbA1c
BG

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26
Q

biomarker in CVD for vascular damage

A

CrCl, Cystatin C, microalbuminuria

27
Q

biomarker in CVD for hemodynamic stress

28
Q

normal EF

A

around 67% (2/3rds of contents ejected out)

29
Q

first line Rx for HFrEF

A

ARBs/ACEIs
beta blockers
ARNI
Aldosterone antagonists

30
Q

specific beta blockers used to treat HFrEF (nbmc)

A

carvedilol
bisoprolol
nebivolol
metoprolol

31
Q

ARNI made up of what 2 drugs

A

Valsartan + Sacubitril

32
Q

Ang II receptor that is involved with maladaptive remodeling

33
Q

what two drugs decrease mortality in patients with HFrEF

A

ACEIs/ARBs and beta blockers

33
Q

mechanistic reasoning why you use beta blockers in HFrEF

A

reduce preload and increase beta receptor density

34
Q

what drugs should not be used in HFrEF

A

cardiac CCB’s

35
Q

SGLT2i

A

-GLIFLOZIN

36
Q

sGC agonists (like NO)

37
Q

second line for HFrEF

A

SGLT2i
sGC agonists
Ivabradine
omecamtiv mecarbil

38
Q

myosin activator used to treat HFrEF

A

Omecamtiv mecarbil

39
Q

act at PCT S1 location and inhibit Na+-glucose cotranporter

A

SGLT2i (-GLIFLOZINs)

40
Q

3rd line treatment of HFrEF and its SE’s

A

Digoxin; yellow eyes and anorexia

41
Q

used to treat AFIB/arrhythmia in HFrEF

A

AMIODARONE

42
Q

HFrEF stage with structural heart disease and treated w/ ARBs/ACEIs

A

stage B or II

43
Q

stage of HFrEF when symptoms start

A

stage C or III

44
Q

rate limiting step of inotropy by myosin activation/inactivation

A

ADP-Pi dissociation

45
Q

prevents premature ADP-Pi dissociation and activates myosin directly

A

Omecamtiv Mecarbil

46
Q

myosin inactivator

A

MAVACAMTEN

47
Q

max reduction in mortality w/ HFrEF

A

OMECAMTIV MECARBIL

48
Q

microvascular endothelial inflammation by comorbidities (decrease in NO)

A

pathogenesis of HFpEF

49
Q

Rx of HFpEF

A

ACEIs/ARBs
ARNI
SGLT2i
antifibrotic agents

50
Q

vasodilator peptide drugs used to treat HFpEF

A

ANP, CNP, urodilantin

51
Q

_____ elevation is pathognomonic for HFpEF

52
Q

ANP and BNP cause what when PKG is activated

A

natriuresis

53
Q

human ANP (hANP)

A

CARPERITIDE

54
Q

human BNP (hBNP)

A

NESERITIDE

55
Q

sign of CHF when you have sob while laying down and it is relieved by standing up

56
Q

causes of acute heart failure

A

MI/ischemia
iatrogenic volume overload

57
Q

symptoms of______ in acute HF include: dyspnea, lower extremity swelling, abdominal discomfort

A

congestion

58
Q

symptoms of _____ in acute HF include: fatigue, dizziness, and confusion

A

low perfusion

59
Q

to treat AHF w/ hypoperfusion

A

dobutamine, dopamine, milrinone

60
Q

to treat AHF w/out volume overload

A

NTG
sodium nitroprusside
nesiritide

61
Q

to treat AHF w/ normotensive and w/ volume overload

A

loop diuretics

62
Q

to treat AHF w/ pulmonary edema

A

vasodilators
diuretics

62
Q

first line treatment for AHF

A

NO donor vasodilators (NTG, sodium nitroprusside)
loop diuretics (furosemide, torsemide)

CVR Biweekly 3 (12 decks)

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