100614 heart failure

Question 1

three major determinants of stroke volume

Answer 1

contractility, preload, afterload

Question 2

afterload is related to

Answer 2

wall stress, which is directly related to aortic pressure and the radius of the ventricle and inversely related to wall thickness of the ventricle

Question 3

point a on pressure volume loop is

Answer 3

mitral valve opening and beginning of diastole

Question 4

point b-c on pressure volume loops is

Answer 4

isovolumic contraction after mitral valve closure

Question 5

d-a on pressure volume loops

Answer 5

isovolumic relaxation after aortic valve closure

Question 6

which pt on P-V loop represents end systolic volume?

Answer 6

d

Question 7

which curve on PV loop is compliance?

Answer 7

ab

Question 8

which curve on PV loops is afterload?

Answer 8

cd

Question 9

what is stroke volume on PV loops?

Answer 9

b - d

Question 10

heart failure is due to abnormal

Answer 10

emptying

filling

Question 11

what are some precipitating factors for heart failure?

Answer 11

increased metabolic demands

increased circulating volume (increases preload)–like salt, renal failure

conditions that increase afterload

conditions that impair contractility

failure to takeheart failure meds

excessively slow HR

Question 12

physical findings for left sided heart failure

Answer 12

diaphoresis
tachycardia, tachypnea
pulmonary rales

loud P2
S3 gallop (in systolic dysfxn)
S4 gallop (in diastolic dysfxn)

Question 13

NY heart association classification of heart failure

Answer 13

class I: mild. cardiac disease, but no limits in physical activity

class II: mild. slight limitation of physical activity. dyspnea and fatigue with moderate exertion.

class III: moderate. marked limitation of physical activity. dyspnea with minimal exertion. comfortable only at rest.

class IV: severe. severe limitation of activity. symptoms present at rest.

Question 14

what is the long term effect of positive inotropes in treating chronic heart failure with reduced ejection fraction?

Answer 14

no beneficial long term effect

Question 15

digoxin primary effects

Answer 15

positive inotrope-increases the contractile state of myocardium, increasing stroke volume

increases vagal tone (slows HR)

Question 16

secondary effects of digoxin

Answer 16

decreases HR
arterial and venous dilation
decreased venous pressure
normalized arterial baroreceptors

Question 17

how does digoxin work as a positive inotrope?

Answer 17

inhibits Na K ATPase

indirectly results in increased intracellular calcium level

Question 18

neurohormonal activation

Answer 18

activation of sympathetic system
activation of renin angiotensin aldoesterone axis
release of ADH

Question 19

side effects of digoxin

Answer 19

really bad

low therapeutic index
affects all excitable tissues (GI, visual, neurologic, muscular, cardiac-arrhythmias)

toxicity enhanced with hypokalemia

drug interactions (quinidine, verapamil, amiodarone)

Question 20

use of digoxin

Answer 20

not first line tx

use limited to heart failure pts with LV systolic dysfxn in atrial fibrillation or in some cases to pts in sinus rhythm who remain symptomatic despite maximal therapy with other therapies

Question 21

furosemide side effect

Answer 21

hypokalemia

Question 22

use of furosemide

Answer 22

widely used chronically for heart failure patients with reduced ejection fraction

Question 23

use of chlorothiazide

Answer 23

rarely used alone

combo therapy with loop diuretics

Question 24

side effect of chlorothiazide

Answer 24

hypokalemia

Question 25

amiloride and triamterene effects as diuretic

Answer 25

weak, but limited K and Mg wasting

Question 26

hydralazine

Answer 26

arterial vasodilator

Question 27

mixed vasodilators ex

Answer 27

ACE inhibitors ARBs isorbide dinitrate/hydralazine combo

Question 28

angiotensin has effects on

Answer 28

potent arterial constrictor (afterload) Na and water retention through aldosterone secretion promotes sympathetic activation by increasing neuronal and adrenal medullary catecholamine release arrhytomogenic promotes myocardial hypertrophy and apoptosis

Question 29

aldosterone effects

Answer 29

promotes water and Na retention and potassium secretion stimulates fibrosis in heart and vasculature cardiac hypertrophy

Question 30

side effects of ACE inhibitors

Answer 30

hyperkalemia angioedema hypotension dry cough

Question 31

use of ARBs

Answer 31

alternative for pts that cannot tolerate ACE inhibitors

Question 32

use of isosorbide dinitrate/hydralazine combo

Answer 32

used when ACE inhibitors or ARBS not tolerated

Question 33

aldosterone antagonist ex

Answer 33

spironolactone, eplerenone

Question 34

side effect of aldosterone antagonist

Answer 34

hyperkalemia

Question 35

uses of aldosterone antagonist

Answer 35

added with moderately severe to severe heart failure

Question 36

non drug therapies for chronic heart failure involving reduced ejection fraction

Answer 36

``` salt restriction bi ventricular pacing implantable cardidefibrillator devices (ICD) left ventricular assist device heart transplant ```

Question 37

tx of heart failure with preserved ejection fraction

Answer 37

diuretics to reduce pulmonary congestion and peripheral edema (but use cautiously to avoid under filling of LV) note: all of the flashcards for drugs before this one (this is the last card) have been for chronic heart failure with reduced ejection fractions