Week 8

Question 1

Heart failure is a disease with two major forms:

Answer 1

1. Heart failure with left ventricular systolic dysfunction
2. Diastolic heart failure

Question 2

How is HF characterized?

Answer 2

HF is a progressive, often fatal disorder characterized by ventricular dysfunction, reduced cardiac output, insufficient tissue perfusion, and signs of fluid retention (e.g., peripheral edema, shortness of breath)

Question 3

Drugs recommended for Heart Failure:

Answer 3

1. diuretics,
2. inhibitors of the renin-angiotensin-aldosterone system (RAAS),
3. beta blockers, and
4. digoxin

Question 4

HF

Answer 4

HF is a syndrome in which the heart is unable to pump sufficient blood to meet the metabolic needs of tissues.

Question 5

Underlying causes of HF

Answer 5

1. Chronic hypertension
2. Myocardial infarction

Question 6

What is the initial phase of heart failure?

Answer 6

In the initial phase of failure, the heart undergoes remodeling, a process in which the ventricles dilate (grow larger), hypertrophy (increase in wall thickness), and become more spherical (less cylindrical).

Question 7

High-output failure

Answer 7

High-output failure is the inability of the heart to adequately supply the body with blood-borne nutrients, despite adequate blood volume and normal or elevated myocardial contractility.

Question 8

Common causes of high-output failure

Answer 8

Common causes of high-output failure are anemia, septicemia, hyperthyroidism, and beriberi

Question 9

Drugs for heart failure

Answer 9

Diuretics

RAAS inhibitors

Beta Blockers

Digoxin

Dopamine

Hydralazine

Question 10

RAAS inhibitors for Heart Failure:

Answer 10

Angiotensin-converting enzyme inhibitor

Angiotensin II receptor blockers

Aldosterone antagonists

Direct Renin inhibitors

Question 11

What are diuretics for?

Answer 11

Diuretics are first-line drugs for all patients with signs of volume overload or with a history of volume overload.

Question 12

By reducing blood volume, diuretics do what?

Answer 12

By reducing blood volume, these drugs can decrease venous pressure, arterial pressure (afterload), pulmonary edema, peripheral edema, and cardiac dilation.

Question 13

What happens if excessive diuresis occurs?

Answer 13

If blood volume drops too low, cardiac output and blood pressure may fall precipitously, thereby further compromising tissue perfusion.

Question 14

Types of Diuretics for Heart Failure:

Answer 14

Thiazide Diuretics

Loop Diuretics

Potassium Sparing Diuretics

Question 15

Thiazide diuretics:

Answer 15

Thiazide diuretics (e.g., hydrochlorothiazide) produce moderate diuresis.

oral agents are used for long-term therapy of HF when edema is not too great.

Question 16

Principle adverse effect of Thiazides

Answer 16

The principal adverse effect of thiazides is hypokalemia, which increases the risk of digoxin-induced dysrhythmias

Question 17

Why are loop diuretics the drug of choice for severe HF?

Answer 17

Because they can mobilize large volumes of water and because they work when GFR is low, loop diuretics are drugs of choice for patients with severe HF.

Question 18

Loop diuretics for Heart Failure

Answer 18

Loop diuretics (e.g., furosemide) produce profound diuresis.

Question 19

Loop diuretics can cause what issues?

Answer 19

1. These drugs can cause hypokalemia, thereby increasing the risk of digoxin toxicity.
2. loop diuretics can cause severe hypotension secondary to excessive volume reduction.

Question 20

Shock

Answer 20

In shock the cardiovascular system fails to perfuse the tissues adequately, resulting in widespread impairment of cellular metabolism.

Question 21

What does shock progress to?

Answer 21

shock progresses to organ failure and death

Question 22

multiple organ dysfunction syndrome (MODS)

Answer 22

multiple organ dysfunction syndrome (MODS) describes the failure of two or more organ systems after severe illness and injury and is a frequent complication of severe shock.

Question 23

In all types of shock what happens to cells?

Answer 23

In all types of shock, the cell either is not receiving an adequate amount of oxygen or is unable to use oxygen.

Question 24

Types of shock:

Answer 24

cardiogenic (caused by heart failure),

hypovolemic (caused by insufficient intravascular fluid volume),

neurogenic (caused by neural alterations of vascular smooth muscle tone),

anaphylactic (caused by immunologic processes), or

septic (caused by infection).

Question 25

Cardiogenic shock

Answer 25

Cardiogenic shock is defined as decreased cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume.