253 - Heart Failure : Management

Question 1

What is the goal of treating HFpEF (3)?

Answer 1

1. Controlling congestion
2. Stabilizing HR and BP
3. Improving exercise tolerance

Question 2

What is the most effective type of treatment to improve HFpEF symptoms?

Answer 2

Decreasing BP

Question 3

How does ARB influence patient management?

Answer 3

Reduce hospitalizations, but does not influence mortality

Question 4

Give 2 examples for ARB drugs

Answer 4

1. Candesartan

2. Irbesartan

Question 5

What may lead to ADHF (Acute Decompensated HF) (6)?

Answer 5

1. Iatrogenic (NSAID)
2. Stimulating drugs for cold/flu
3. Licorice/Ginseng
4. Infection
5. PE
6. Arrhythmias

Question 6

What are the lab parameters linked to poor results (4)?

Answer 6

1. BUN > 43
2. BP < 115
3. Creatinine > 2.75
4. Troponin increase

Question 7

How will you relieve congestion?

Answer 7

Diuretic until euvolemic state

Question 8

What is the cardiorenal syndrome?

Answer 8

The relationship between cardiac and renal dysfunction- the damage of one organ when treating the other

Question 9

What is the effect of long term usage of diuretics (2)?

Answer 9

1. Decrease GFR

2. Worsening of cardiorenal syndrome ]

Question 10

How will you improve patients until definitive treatment?

Answer 10

Inotropic treatment or circulatory support showed improvement of renal function in the short run

Question 11

What is ultrafiltration?

Answer 11

Invasive technique to remove fluids without effecting the electrolytes in the serum

Question 12

When will we use UF?

Answer 12

When treatment with diuretics is non responsive

Question 13

What does the vascular therapy include?

Answer 13

Vasodilatation:

1. Nitrates (nitroprusside, nesiritide)
2. Serelaxin

Question 14

List 2 inotropic drugs?

Answer 14

1. Dobutamine

2. Phosphodiesterase 3 blockers (Milrinone)

Question 15

What is the mechanism of inotropic therapy (4)?

Answer 15

• > Increase in intracellular calcium
• > Increase in CO
• > Improves perfusion
• > Reduce congestion

Question 16

What are the risks in inotropic drugs?

Answer 16

Increases mortality in the long run

Question 17

When will you use inotropic drugs (2)?

Answer 17

1. Therapeutic bridge towards definitive treatment (LVAD/Heart transplantation)
2. Palliation

Question 18

Name two inotropic drugs

Answer 18

1. Dobutamine

2. Milrinone

Question 19

What is the leading diuretic drug?

Answer 19

Furosemide

Question 20

What are the leading drug groups improving prognosis of HFrEF patients?

Answer 20

1. RAAS

2. Beta blocker

Question 21

What is the first line in HFrEF treatment?

Answer 21

BB+ACEI
 or
BB+ARB
 or 
ACEI+ARB
 or
Hydralazine+ nitrates

Question 22

Name 3 BB drugs for HFrEF treatment

Answer 22

1. Carvedilol
2. Bisoprolol
3. Metoprolol

Question 23

What is the second line in HFrEF treatment?

Answer 23

Aldosterone antagonist:

Eplerenone or Spironolactone

Question 24

Name 3 ACEI drugs

Answer 24

1. Lisinopril
2. Enalapril
3. Captopril

Question 25

Name 3 ARB drugs

Answer 25

1. Losartan
2. Valsartan
3. Candesartan

Question 26

Name an ARNI (Angiotensin Receptor Neprilysin Inhibitor) drug

Answer 26

Sacubitril-valsartan

Question 27

When will you prescribe heart rate modification drug such as Ivabradine for HFrEF patient?

Answer 27

Patients under ACEI+ BB+ mineralocorticoid receptor agonist AND HR>70 AND symptomatic

Question 28

Which patients will be treated with digoxin for HFrEF?

Answer 28

Digoxin is indicated for patients who are still symptomatic under full treatment

Question 29

Name 2 CCB drugs

Answer 29

1. Amlodipine

2. Felodipine

Question 30

When will you prescribe CCB for HFrEF?

Answer 30

To decrease BP

• Do not influence mortality/morbidity/life quality
• • Never use first gen drugs (Verapamil/ diltiazem)

Question 31

Which patients are eligible for ICD

Answer 31

1. Post SCD
2. EF<35% AND NYHA 2-3
3. EF<30%