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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
Q

Week 238

Which term is used to describe a combination of both L and R heart failure?

A

Congestive heart failure.

26
Q

Week 238

What is Cardiac Cachexia?

A

Weight loss and anorexia commonly seen in HF.

Causes metabolic changes, gut congestion, reduced intake, inflammatory causes.

27
Q

Week 238

What is Systolic Heart Failure?

A

Symptoms and signs of
heart failure with LV
systolic dysfunction.

28
Q

Week 238

What is Diastolic heart failure?

A

Symptoms and signs of
heart failure with
preserved LV systolic
function

50% of HF patients

29
Q

Week 238

B type natriuretic peptide (BNP) and N terminal proBNP (NT-proBNP) rise in response to what?

A

Myocaridal wall stress - aka Heart failure.

30
Q

Week 238

If a heart failure patient has electrical dysynchrony - what treatment can you use to correct it?

A

CRT-P

synchronises inter and intraventricular contraction.

31
Q

Week 238

How do you manage acute Left Ventricular failure?

A

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
Q

Week 238

In pulmonary oedema rapid relief will be
obtained by the use of iv _____ (venodilator
and fluid removal).

A

Ferusomide

33
Q

Week 238

Thiazides and related compounds (metolazone) act at the beginning of the______convoluted tubule to inhibit _____reabsorption.

A

Distal

Sodium

34
Q

Week 238

Bendroflumethiazide
•
Chlortalidone
•
Indapamide
•
Cyclopenthiazide
•
Hydrochlorothiazide
•
Metolazone

These are all what type of drug?

A

Thiazide and related diuretics

Side effects

  • Electrolyte disturbances
  • (Na+ and K+)
  • Gout (urate)
  • Hyperglycaemia
  • Derranged lipids
35
Q

Week 238

Furosemide and Bumetanide are what type of drug? What are they often used in conjuction with, and why?

A

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
Q

Week 238

Amiloride and spironolactone are what type of drug?

A

These are potassium sparing diuretics.

37
Q

Week 238

Opiates don’t just stop pain. They are also venodilators. What effect does this have?

A

This reduces pre-load and sympathetic drive.

38
Q

Week 238

Cyclisine is an anti-emetic. Why is it not given to patients with heart failure? What can you give instead?

A

Cyclisine causes vasoconstriction.

Use metoclopramide instead.

39
Q

Week 238

What type of drug is Nitroglycerine? What does it do?

A

It is a Vasodilator.

Reduces preload, afterload and increases stroke volume

No evidence they relieve dyspnoea or any other clinical outcomes.

40
Q

Week 238

What is Nesiritide? What effect does it have?

A

It’s a vasodilator

Human BNP. A vasodilator shown to
reduce dyspnoea in addition to conventional effects.
.

41
Q

Week 238

Dobutamine, levosimendan, or the PDIII inhibitor - milrinone, are what type of drugs? When are they used?

A

They are + inotropes

They are used (sometimes - on ITU) in cardiogenic shock

42
Q

Week 238

What is refractory heart failure?

A

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
Q

Week 238

ACE-Inhibitors are indicated for all patients in HF with an LVEF less than ____%

A

40%

44
Q

Week 238

Name some uses/benefits of ACE-I’s

A

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
Q

Week 238

The prognostic value of which two Ace Inhibitors is shown in IHD independent of effects on LV function

A
46
Q

Week 238

Name some contraindications to the use of Ace Inhibitors.

A

Severe AS/MS/LVOT obstruction,e.g. HCM

Bilateral renal artery stenosis

Pregnancy

History of idiopathic/hereditary angioedema

Creatinine > 220mol/l

47
Q

Week 238

Drugs ending in “Sartan” are which class?

A

These are Angiotensin 2 receptor antagonists.

i.e. Candesartan, and valsartan

48
Q

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%?

A

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
Q

Week 238

When are Aldosterone Antagonists (i.e. spironolactone and Eplerenone) indicated?

A 
Aldosterone antagonists indicated for severe
symptomatic HF (grade III/IV) with LVEF\< 35%).
50
Q

Week 238

What are the main contraindications for the use of Beta blockers?

A

•
Asthma/COPD
•
Cardiac conduction defects
•
Severe heart failure
•
Severe peripheral vascular
disease
•
Raynaud’s
disease
•
Unopposed in phaeochromocytoma (must use with alphablocker)

51
Q

Week 238

Labetalol is a beta blocker. In which circumstances is it best used/most useful?

A

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
Q

Week 238

What does Ivabradine do?

A

Inhibits the I/f channel in the sinus node, slowing the heart rate in sinus rhythm (but not in AF).

53
Q

Week 238

Which drugs can cause or contribute to heart failure?

A
  • NSAIDS and co-2 inhibitors
  • Anthracylines
  • Verapamil and diltiazem
  • glitazones
  • clozapine
  • TNF alpha inhibitors i.e. infliximab
  • itraconazole
  • liquorice
  • TCA’s
54
Q

Week 238

What effect does Digoxin have?

A
  • Increases cardiac contractility
  • Slows heart rate

Medicine Year 2 (Bear) (30 decks)

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