Heart Failure

Question 1

HRrEF impairment in cardiac function

Answer 1

systolic dysfunction: decreased contractility

Question 2

HFpEF impairment in cardiac function

Answer 2

diastolic dysfunction: impairment in ventricular relaxation/filling

Question 3

HFrEF definition

Answer 3

HF symptoms with EF < 40%
(could be asymptomatic reduced EF)

Question 4

HFpEF definition

Answer 4

HF symptoms with EF > 50%

Question 5

70% of HFrEF cases are caused by ____________ ___________ _______________

Answer 5

ischemic dilated cardiomyopathy

Question 6

3 determinants of left ventricular function:

Answer 6

1. Preload (venous return, LVEDV)
2. Myocardial contractility (force generated at any given LVEDV)
3. Afterload (aortic impedance and wall stress)

Question 7

Drug-induced heart failure: negative ionotropics

Answer 7

1. Antiarrhythmics (disopyramide, flecainide)
2. B-blockers
3. CCBs (non-DHP)
4. Itraconazole

Question 8

Drug-induced heart failure: direct cardiac toxins

Answer 8

Doxorubicin, Bevacizumab, blue cohosh, imatinib, ethanol, cocaine, amphetamines

Question 9

Drug-induced heart failure: sodium/water retention

Answer 9

Glucocorticoids, androgens, estrogens, NSAIDs, COX2 inhibitors, rosiglitazone and pioglitazonee, Na+ containing drugs (i.e. carbenicillin DiNa+)

Question 10

Clinical presentation of HF examples

Answer 10

SOB
swelling of feet/legs
difficulty sleeping due to breathing problems swollen abdomen with loss of appetite
cough with frothy sputum
increased urination at night

Question 11

Right ventricular failure: S/Sx
(systemic venous congestion)

Answer 11

Sx: abdominal pain, nausea, bloating, constipation, anorexia

Signs: peripheral edema, JVD, HJR, hepatomegaly, ascites

Question 12

Left ventricular failure: S/Sx
(pulmonary congestion)

Answer 12

Sx: dyspnea on exertion, orthopnea, bendopnea, PND, tachypnea, cough

Signs: rales, pulmonary edema, pleural effusion

Question 13

Other major non-specific HF findings

Answer 13

1. Fatigue/weakness
2. Exercise tolerance
3. Nocturia
4. Cardiomegaly

Question 14

BNP > ______ pg/mL may be indicative of heart failure

Answer 14

> 35

Question 15

NT-proBNP > ______ pg/mL may be indicative of heart failure

Answer 15

> 125

Question 16

HF NYHA classes

Answer 16

I: cardiac disease w/o resulting limitations of physical activity
II: cardiac disease resulting in slight limitations of physical activity
III: cardiac disease resulting in limitations of physical activity
IV: cardiac disease resulting in inability to carry on any physical activity w/o discomfort

Question 17

HF AHA Stage A

Answer 17

High risk of developing HF (HTN, CAD, DM)

Question 18

HF AHA Stage B

Answer 18

structural heart disease that is strongly associated with HF but NO s/sx of HF

Question 19

HF AHA Stage C

Answer 19

current or prior symptoms of HF associated with underlying heart disease

Question 20

HF AHA Stage D

Answer 20

advanced structural heart disease and marked symptoms of HF at rest despite maximal medical therapy and require specialized interventions

Question 21

NYHA FC I is equal to which AHA stage?

Answer 21

Stage B

Question 22

AHA stage C is equal to which NYHA classes?

Answer 22

NYHA II + III

Question 23

NYHA FC IV is equal to which AHA stage?

Answer 23

Stage D

Question 24

Asymptomatic rEF is what stage and what class?

Answer 24

Stage B
NYHA FC I

Question 25

What drugs reduce intravascular volume?

Answer 25

diuretics, SGLT2i

Question 26

What drugs increase myocardial contractility?

Answer 26

positive inotropes

Question 27

What drugs decrease ventricular afterload?

Answer 27

ACEi
vasodilators
SGLT2i

Question 28

What are the 5 GDMT drug classes?

Answer 28

1. ARNI/ACEi/ARB
2. Beta-blocker (metoprolol succ, carvedilol, bisoprolol)
3. aldosterone antagonist
4. SGLT2i
5. Loop diuretic

Question 29

Mechanism of action of aldosterone antagonists IN HF

Answer 29

block aldosterone’s effects and reduce cardiac remodeling
(NOT used for diuretic effect in HF)

Question 30

What are the 3 beta-blockers used for HFrEF?

Answer 30

Carvedilol
Bisoprolol
Metoprolol succinate

Question 31

Diuretics do not decrease _________, but instead decrease hospitalizations

Answer 31

mortality

Question 32

Patients w/o symptoms of ________ ___________ should not receive diuretics

Answer 32

volume overload

Question 33

What is an additional benefit of loop diuretics for HFrEF patients?

Answer 33

enhances renal release of prostaglandins, which increases renal blood flow and enhances venous capacitance

Question 34

Furosemide 80mg PO = ______ mg IV

Answer 34

40

Question 35

Furosemide 40mg IV = bumetanide ______mg IV

Answer 35

1mg

Question 36

Bumetanide 1mg IV = Torsemide ______ mg IV

Answer 36

20

Question 37

Thiazide diuretics may be used in what patients?

Answer 37

Mild HF patients
Pts with small amounts of fluid retention

Question 38

Furosemide usual dose range

Answer 38

20-160mg QD or BID

Question 39

Bumetanide usual dose range

Answer 39

1-2mg QD or BID

Question 40

Torsemide usual dose range

Answer 40

10-80mg QD

Question 41

HCTZ initial + maximum dose in HF

Answer 41

initial: 25mg/day
max: 100mg/day

Question 42

Metolazone initial + maximum dose in HF

Answer 42

initial: 2.5mg/day
max: 10mg/day

Question 43

Thiazides can cause ______calcemia while loops may cause ______calcemia

Answer 43

Thz = hyper
Loop = hypo

Question 44

Hypotension and increase SCr or BUN/Cr ratio may be indicative of what?

Answer 44

Volume depletion
(BUN/Cr > 20:1 indicates dehydration and prerenal azotemia)

Question 45

BUN/Cr normal ratio

Answer 45

15:1

Question 46

While taking a thiazide, replace K+ if below _____mEq/L and replace Mg2+ if below _____mEq/L

Answer 46

K+ < 4mEq/L
Mg2+ < 2mEq/L

Question 47

Why is treating hypokalemia and hypomagnesemia important in HF patients?

Answer 47

Because they can cause pump failure and arrhythmias if left untreated

Question 48

What is one of the most important benefits of ACE inhibitors for HF patients?

Answer 48

inhibition of cardiac hypertrophy/reduction in remodeling