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MKSAP > Cardiology – Heart Failure > Flashcards

Cardiology – Heart Failure Flashcards

1
Q

Clinical differences in HFrEF vs HFpEF?

A

HFpEF patients will have

#higher heart rate to maintain normal cardiac output
#More sensitive to volume due to small LV
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2
Q

Role for serial BNPs?

A

None

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3
Q

Initial labs for heart failure should include?

A 
BMP
UA
Lipids
LFTs
TSH

Do not do any more labs unless suggested by history or physical

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4
Q

Most important diagnostic test in the evaluation of heart failure?

Potentially better test? Advantages?

A

ECHO

cMRI
#Can assess wall motion abnormalities, global wall function,
#Viability
#Tissue perfusion
#Tissue injury (inflammation, necrosis, fibrosis, infiltration, iron deposition)
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5
Q

Valve abnormality that is secondary to heart failure?

A

Mitral regurgitation

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6
Q

Left ventricular hypertrophy magnitude in HFpEF (vs HFrEF)?

LVH in HFpEF is generally due to?

A

Mild to moderate (under 15 mm in any region)

Hypertension

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7
Q

When to perform endomyocardial biopsy for acute heart failure?

Goal of biopsy?

A 
#Progressive heart failure on
#medical therapy with 
#malignant arrhythmias

Evaluate for Giant cell myocarditis

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8
Q

Infiltrative disease that is least likely to be discovered on endomyocardial biopsy?

A

Sarcoidosis (patchy)

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9
Q

Role for routine right heart catheterization in patients with heart failure?

However, it may be useful for?

A

None

#Patients with heart failure refractory to medical therapy
#Transplant candidates
#Before using inotropic agents or more aggressive diuresis
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10
Q

Medications that decrease mortality in patients with HFrEF?

Therapies that improve symptoms?

A 
#ACE inhibitors/ARBs
#Beta blockers
#Aldosterone antagonist
#Hydralazine/isosorbide dinitrate (for black patients in NYHA class III/IV)

Digoxin
Diuretics
Iontropic agents
Vasodilators

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11
Q

Benefit of high dose versus low dose ACE inhibitor? (Interval of uptitrating)

Beta-blocker?

A

Decreased hospital admissions but no difference in mortality (up to daily)

Mortality reduction and heart failure symptoms (uptitrating q1-2 weeks)

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12
Q

In patient with HFrEF, when to reconsider starting ACE inhibitor?

A

Creatinine over 3.0

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13
Q

Side effect of ACE inhibitors that warrant switching to angiotensin receptor blocker? Side effect that rules out both?

A

Cough

Angioedema

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14
Q

Therapeutic doses of beta blockers for treatment of HFrEF?

A

Metoprolol Succinate 200
Carvedilol 25 BID
Bisoprolol 10

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15
Q

Digoxin- benefits?

A

In Short-term, improved symptoms, quality-of-life, and exercise tolerance

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16
Q

Digoxin - patients at risk to develop toxic levels?

Level associated with increased risk of mortality?

A 
#Elderly
#Low body mass
#Kidney impairment

Over 1 ng/mL

17
Q

Aldosterone antagonists have mortality/mobility benefits in NYHA Class II if?

A

Prior hospitalization or elevated BNP

18
Q

Lab values that prohibit the use of aldosterone antagonists?

A 
#Creatinine above 2.5 in men or above 2 in women
#Potassium over 5
19
Q

Pathophysiology of HFrEF vs HFpEF?

A

Abnormality of myocardio contraction (reduced systolic function result in progressive ventricular dilation)

Abnormality in diastolic relaxation (results in restricted feeling and High filling pressures)

20
Q

Antihypertensives that should be discontinued once a diagnosis of heart failure has been made?

A

Dihydropyridine’s (diltiazem or verapamil)

Amlodipine or felodipine can be continued

21
Q

Medications with a mortality benefit in HFpEF?

A

None

22
Q

How common is sudden cardiac death in patients with heart failure? Only reliable predictor of an arrhythmic event is?

A

50%

LVEF

23
Q

Indications for ICD for primary prevention in heart failure?

For secondary prevention?

A 
#NYHA class II or III on medical therapy
#Expected survival over one year
And one of the following for primary prevention:
#Ischemic cardiomyopathy over 40 days post MI
#Nonischemic cardiomyopathy with EF under 35
For secondary prevention:
#History of Hemodynamically significant ventricular arrhythmia or cardiac arrest
24
Q

Should only place ICD in patients with reduced life expectancy if?

A 
#Awaiting transplantation
#Awaiting placement of mechanical circulatory device
25
Q

Pacing lead in ICD is placed?

Additional pacing lead in CRT is placed?

A

Apex of right ventricle

Coronary sinus

26
Q

CRT indications?

A 
#LVEF under 35%
#LBBB with QRS>150
#NYHA Class III or IV (maybe II) on medical therapy
27
Q

Valve abnormality that arise after CRT?

A

Tricuspid regurgitation

28
Q

Bad prognostic signs in patients with heart failure?

Bad prognostic signs on cardiopulmonary exercise testing?

A 
#NYHA class IV
#Repeat hospitalizations
#Hyponatremia under 133
#Worsening kidney function
#Intolerance of ACE inhibitors or beta blockers
#Arrhythmias resulting in ICD firings
#Low oxygen consumption (under 14 ml/kg/min)
#High ratio of ventilation-to-carbon dioxide production (over 34)
29
Q

Patient with acute decompensated heart failure. When to discontinue beta blocker?

A 
Low output heart failure:
#Hypotension
#Worsening kidney/liver function
#Cool extremities
30
Q

Ultrafiltration versus IV diuretics in decompensated heart failure?

A

Worsened kidney function

31
Q

Drug that can be used for the treatment of hyponatremia in patients with heart failure?

A

Vasopressin antagonists

32
Q

Cardiogenic shock - drugs that increase inotropy and vasodilate?

Drugs that increase inotropy and vasoconstrict?

Drug that increases inotropy and can either vasodilate or vasoonstrict?

A

Milrinone (PDE inhibitor)

Dopamine
Norepinephrine

Dobutamine (dilates at low doses, constricts at high doses)

33
Q

Cardiogenic shock – drugs that purely vasodilate?

A

Sodium nitroprusside
Nitroglycerin
Nesiritide (Natriuretic peptide receptors)

34
Q

Cardiogenic shock – drug that is a negative inotrope and Vasoconstricts?

A

Vasopressin

35
Q

Complications related to LVADs?

A 
#Driveline related infections
#G.I. bleeding from AV malformation's
#Ischemic/hemorrhagic stroke
36
Q

Three drug immunosuppressive regimen after heart transplant?

A 
#Calcineurin inhibitor (cyclosporine or tacrolimus)
#Antiproliferative agent #Mycophenolate, sirolimus, everolimus)
Prednisone
37
Q

Signs of rejection after transplant? Rate of rejection in the first year? subsequently?

A

Heart failure and atrial arrhythmias (atrial flutter)

20%

Nonexistent if medication compliant

38
Q

Long term Complications of heart transplant?

A

Cardiac allograft vasculopathy (diffuse intimal thickening of the cornary arteries from distally to proximally)

Malignancy (lymphoproliferative disorders and skin cancer)

39
Q

Cardiac transplant patients do not experience typical ischemic chest pain because?

Because of this, resting heart rate is usually between?

Also, patients are not responsive to these drugs?

A

Transplanted heart is denervated

90-110 (no vegal innervation)

Atropine or digoxin

MKSAP (14 decks)

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