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Medicine Year 2 (Bear) > Week 238 - Heart failure > Flashcards

Week 238 - Heart failure Flashcards

1
Q

Week 238

In the medical management of acute left ventricular failure:

Name a drug with venodilator and diuretic properties often used intravenously.

A

Furosemide

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2
Q

Week 238

In the medical management of acute left ventricular failure

Name an intravenous venodilator used to lower pre
-load, also used sublingually in angina management..

A

Glycerol Trinitrate

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3
Q

Week 238

In the medical management of acute left ventricular failure:

Name an intravenous agent used to reduce the anxiety and distress of dyspnoea.

A

Diamorphine

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4
Q

Week 238

Name a drug acting at the loop of Henle to inhibit sodium reabsorption

A

Furosemide

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5
Q

Week 238

Name a thiazide related diuretic unsuitable for acute left ventricular failure and reserved exclusively for
refractory chronic heart failure

A

Metolazone

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6
Q

Week 238

Name a loop diuretic 1 mg of which is equivalent to 40 mg of furosemide

A

Bumetanide

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7
Q

Week 238

Name a beta blocker only licensed for use in chronic heart failure

A

Carvedilol

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8
Q

Week 238

Name a drug that Inhibits the I/f channel in the sinus node

A

Ivabradine

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9
Q

Week 238

RE: Heart failure. Name a drug that is Potassium sparing and can cause gynaecomastia

A

Spironolactone

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10
Q

Week 238

If your heart failure patient is already on a beta blocker, and still has a heart rate of more than 70bpm, which drug could you give them next?

A

Ivabradine

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11
Q

Week 238

In the investigation of chronic heart failure:

Which result has a low value that has a high negative predictive value making heart failure unlikely in an untreated patient (also can be used as a prognostic marker)

A

Brain natriuretic peptide

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12
Q

Week 238

Which investigation “Gives a functional assessment of coronary perfusion also giving information on
myocardial scarring, ejection fraction and prognosis in coronary artery disease”?

A

Perfusion scintigraphy

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13
Q

Week 238

Which investigation
has a value which can distinguish between
systolic and diastolic
heart failure?

A

Ejection fraction

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14
Q

Week 238

Which investigation (for Heart failure) is useful in identifying hibernating myocardium?

A

Perfusion Scintigraphy

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15
Q

Week 238

Kerley B lines appear on what type of investigation - and as a result of which lung pathology?

A

Chest x ray

Result of pulmonary oedema

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16
Q

Week 238

What is the most likely cause of
Heart failure occurring during pregnancy or within
6 months of delivery?

A

Peripartum Cardiomyopathy

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17
Q

Week 238

What is the cause of
Heart failure occurring as a consequence of long standing poorly controlled atrial fibrillation?

A

Tachycardia induced cardiomyopathy

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18
Q

Week 238

What is the name given to a form of heart failure seen as consequence of chronic alcohol abuse?

A

Dilated cardiomyopathy

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19
Q

Week 238

What is the name given to a form of
heart failure associated with hypertension, diabetes mellitus and left ventricular hypertrophy?

A

Heart failure with preserved
ejection fraction

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20
Q

Week 238

What is the name given to a form of heart failure associated with chronic obstructive airways disease and interstitial lung disease?

A

Cor Pulmonale

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21
Q

Week 238

Define: Heart failure

A

A failure of cardiovascular function to maintain cardiac output to meet the body’s metabolic demands despite normal venous pressures

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22
Q

Week 238

What are the classical symptoms of Left Heart Failure related to?

A
  • Pulmonary venous congestion
  • Dyspnoea (Shortness of breath)
  • Orthopnoea (SOB when lying flat)
  • Paroxysmal Nocturnal Dyspnoea
23
Q

Week 238

What are the classical symptoms of Right sided heart failure related to?

A

Systemic venous congestion.

  • Peripheral oedema
  • Elevated JVP
  • Hepatomegaly
  • Ascites
24
Q

Week 238

Name some causes of Right Heart Failure.

A

Chronic lung disease eg COPD, Fibrotic lung disease
(Cor pulmonale)
•
Pulmonary hypertension, eg PE
•
Left to right intracardiac
shunts, eg ASD, VSD (plus Eisenmenger syndrome)
•
Chronic valvular heart disease or LV dysfunction

25
Week 238 Which term is used to describe a combination of both L and R heart failure?
Congestive heart failure.
26
Week 238 What is **Cardiac Cachexia**?
Weight loss and anorexia commonly seen in HF. Causes metabolic changes, gut congestion, reduced intake, inflammatory causes.
27
Week 238 What is **Systolic Heart Failure**?
Symptoms and signs of heart failure with LV systolic dysfunction.
28
Week 238 What is **Diastolic heart failure**?
Symptoms and signs of heart failure with preserved LV systolic function 50% of HF patients
29
Week 238 B type natriuretic peptide (BNP) and N terminal proBNP (NT-proBNP) rise in response to what?
Myocaridal wall stress - aka Heart failure.
30
Week 238 If a heart failure patient has electrical dysynchrony - what treatment can you use to correct it?
**CRT-P** synchronises inter and intraventricular contraction.
31
Week 238 How do you manage **acute Left Ventricular failure**?
Oxygen • Diamorphine 2.5 mg, iv (or morphine) • Metoclopramide 10 mg, iv • Furosemide 40 - 80 mg, iv • iv nitrates (glyceryl trinitrate/ISDN) • For refractory cases consider non - invasive or mechanical ventilation.
32
Week 238 In pulmonary oedema rapid relief will be obtained by the use of iv _____ (venodilator and fluid removal).
Ferusomide
33
Week 238 **Thiazides** and related compounds (metolazone) act at the beginning of the\_\_\_\_\_\_convoluted tubule to inhibit \_\_\_\_\_reabsorption.
Distal Sodium
34
Week 238 Bendroflumethiazide • Chlortalidone • Indapamide • Cyclopenthiazide • Hydrochlorothiazide • Metolazone These are all **what type** of drug?
**Thiazide** and related diuretics **_Side effects_** * Electrolyte disturbances * (Na+ and K+) * Gout (urate) * Hyperglycaemia * Derranged lipids
35
Week 238 **Furosemide** and **Bumetanide** are **what type** of drug? What are they often used in conjuction with, and why?
These are **loop diuretics.** Often used in combination with **K+- sparing diuretics** to **prevent hypokalaemia**, e.g. **amiloride or spironalactone** e.g. Co-amilofruse or Frumil, 5/40.
36
Week 238 Amiloride and spironolactone are what type of drug?
These are potassium sparing diuretics.
37
Week 238 Opiates don't just stop pain. They are also **venodilators**. What effect does this have?
This reduces pre-load and sympathetic drive.
38
Week 238 Cyclisine is an anti-emetic. **Why is it not** given to patients with heart failure? **What** can you give instead?
**Cyclisine causes vasoconstriction**. Use **metoclopramide** instead.
39
Week 238 What type of drug is **Nitroglycerine**? What does it do?
**It is a Vasodilator.** **Reduces preload, afterload and increases stroke volume** No evidence they relieve dyspnoea or any other clinical outcomes.
40
Week 238 What is **Nesiritide**? What effect does it have?
It's a **vasodilator** Human BNP. A vasodilator shown to **reduce dyspnoea** in addition to conventional effects. .
41
Week 238 Dobutamine, levosimendan, or the PDIII inhibitor - milrinone, are **what type of drugs**? When are they used?
They are **+ inotropes** They are used (sometimes - on ITU) in cardiogenic shock
42
Week 238 What is **refractory** heart failure?
Refractory CHF is defined as **symptoms of CHF at rest or repeated exacerbations of CHF despite “optimal” triple-drug therapy.** Most patients with refractory CHF require hemodynamic monitoring and treatment in the intensive care unit.
43
Week 238 ACE-Inhibitors are indicated for all patients in HF with an LVEF less than \_\_\_\_%
40%
44
Week 238 Name some uses/**benefits of ACE-I's**
Wide body of evidence for use in heart failure. First line treatment young hypertensive.Reduction in proteinuria/preservation renal function in diabetic nephropathy. Prognostic benefits in patients with IHD and preserved LV function.
45
Week 238 The prognostic value of which two **Ace Inhibitors is shown in IHD independent of effects on LV function**
46
Week 238 Name some contraindications to the use of Ace Inhibitors.
Severe AS/MS/LVOT obstruction,e.g. HCM Bilateral renal artery stenosis Pregnancy History of idiopathic/hereditary angioedema Creatinine \> 220mol/l
47
Week 238 Drugs ending in "Sartan" are which class?
These are Angiotensin 2 receptor antagonists. i.e. Candesartan, and valsartan
48
Week 238 If you have a patient that can't tolerate ACE-Inhibitors, or Angiotensin Receptor Blockers, **What could you use instead, if LVEF \<40%**?
Use **Isosobide dinitrate and hydralazine** if ACEI/ARB not tolerated or in addition to ACEI/ARB/C=B-Blocker/digoxin/aldosterone antagonist if still symptomatic and LVEF \< 40%.
49
Week 238 When are **Aldosterone Antagonists** (i.e. spironolactone and Eplerenone) indicated?
``` Aldosterone antagonists indicated for severe symptomatic HF (grade III/IV) with LVEF\< 35%). ```
50
Week 238 What are the main **contraindications** for the use of **Beta blockers?**
• Asthma/COPD • Cardiac conduction defects • Severe heart failure • Severe peripheral vascular disease • Raynaud’s disease • Unopposed in phaeochromocytoma (must use with alphablocker)
51
Week 238 Labetalol is a beta blocker. **In which circumstances is it best used/most useful**?
Labetolol: an alpha and Beta adrenoceptor blocker **Useful in pregnancy** and as an iv infusion **in the rapid control of BP e.g. in aortic dissection**
52
Week 238 What does **Ivabradine** do?
Inhibits the I/f channel in the sinus node, slowing the heart rate in sinus rhythm (but not in AF).
53
Week 238 Which **drugs can cause or contribute** to heart failure?
* NSAIDS and co-2 inhibitors * Anthracylines * Verapamil and diltiazem * glitazones * clozapine * TNF alpha inhibitors i.e. infliximab * itraconazole * liquorice * TCA's
54
Week 238 What effect does **Digoxin** have?
* Increases cardiac contractility * Slows heart rate

Medicine Year 2 (Bear) (30 decks)

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