44: AGENTS FOR TREATING HEART FAILURE

Question 1

resistance/pressure against which the heart has to push

Answer 1

afterload

Question 2

volume of blood being pumped by the heart; cardiac output = heart rate x stroke volume

Answer 2

cardiac output

Question 3

enlargement of the heart, commonly seen with chronic hypertension, valvular disease, and heart failure

Answer 3

cardiomegaly

Question 4

disease of the heart muscle that leads to a weakened heart and can eventually lead to complete heart muscle failure and death

Answer 4

cardiomyopathy

Question 5

discomfort with respirations, often with a feeling of anxiety and inability to breathe; seen often with left- sided heart failure

Answer 5

dyspnea

Question 6

condition in which the heart muscle has less ability to adequately pump blood around the cardiovascular system, leading to a backup or congestion of blood in the system

Answer 6

heart failure (HF)

Question 7

blood-tinged sputum seen in left-sided heart failure when blood backs up into the lungs and fluid leaks out into the lung tissue (coughing up of blood)

Answer 7

hemoptysis

Question 8

getting up to void at night, reflecting increased renal perfusion with fluid shifts in the supine position when a person has gravity-dependent edema related to heart failure or other medical conditions, including urinary tract infection, increasing the need to get up and void

Answer 8

nocturia

Question 9

difficulty breathing when lying down, oftenreferred to by the number of pillows required to allow a person to breathe comfortably

Answer 9

orthopnea

Question 10

describes an agent that causes an increased force of muscle contraction

Answer 10

positive inotropic

Question 11

amount of blood that is brought back to the heart to be pumped throughout the body; this blood exerts pressure on the heart ventricles

Answer 11

preload

Question 12

increased fluid in the lung tissue that can be due to left-sided heart failure

Answer 12

pulmonary edema

Question 13

rapid and shallow respirations that can be seen with left-sided heart failure

Answer 13

tachypnea

Question 14

are often used to decrease the workload and oxygen consumption of the heart

Answer 14

antianginal medications

Question 15

are drugs used to increase the contractility of the heart muscle for patients experiencing heart failure

Answer 15

cardiotonic agents

Question 16

These are the medications that are used if the patient is not able to tolerate medications that lower heart rate and blood pressure due to weakening of the heart muscle

Answer 16

cardiotonic agents and hyperpolarization-activated cyclic nucleotide-gated channel blockers (HCN blockers)

Question 17

at high risk for HF but without structural heart disease or symptoms of HF

Answer 17

Stage A

Question 18

Structural heart disease but without signs or symptoms of HF

Answer 18

Stage B

Question 19

Structural heart disease with prior or current symptoms of HF

Answer 19

Stage C

Question 20

Refractory HF requiring specialized interventions

Answer 20

Stage D

Question 21

No limitation on physical activity. ordinary physical activity does not cause symptoms of HF

Answer 21

Class I

Question 22

Slight limitation of physical activity. comfortable at rest, but ordinary physical activity results in symptoms of HF

Answer 22

Class II

Question 23

Marked limitations of physical activity. Comfortable at rest, but less than ordinary activity causes symptoms of HF

Answer 23

Class III

Question 24

Unable to perform any physical activity without symptoms of HF, or there are symptoms of HF at rest

Answer 24

Class IV

Question 25

Normal ejection fraction of the left ventricle is about?

Answer 25

55% - 70%

Question 26

what are the two contractile proteins of sarcomere?

Answer 26

Actin and Myosin

Question 27

Actin and myosin are highly reactive with each other but at rest are kept apart by this chemical

Answer 27

Troponin

Question 28

it enters the cell and inactivates the troponin when a cardiac muscle is stimulated, allowing the actin and myosin to form actomyosin bridges

Answer 28

Calcium

Question 29

The formation of these bridges allows the muscle fibers to slide together or contract

Answer 29

actomyosin bridges

Question 30

is one of the leading causes of heart failure

Answer 30

coronary artery disease

Question 31

results in an insufficient supply of blood to meet the oxygen demands of the myocardium

Answer 31

coronary artery disease

Question 32

there is enlarged liver (hepatomegaly), enlarged spleen (splenomegaly), decreased blood flow to the gastrointestinal (GI) tract causing feelings of nausea and abdominal pain, swollen legs and feet, and dependent edema in the coccyx or other dependent areas with decreased peripheral pulses and hypoxia of those tissues.

Answer 32

right side heart failure

Question 33

RIGHT SIDE HEART FAILURE 1. elevated jugular venous presssure 2. splenomegaly 3. hepatomegaly 4. decreased renal perfusion when upright 5. increase renal perfusion when supine = nocturia 6. pitting edema 7. weakness/fatigue

Question 34

LEFT SIDE HF 1. anxiety 2. tachypnea, dyspnea, orthopnea, hemoptysis, rales 3. cardiomegaly 4. increased heart rate 5. GI upset, nausea, abdominal pain 6. decreased peripheral pulses 7. hypoxia

Question 35

usually occurs as a result of chronic obstructive pulmonary disease or other lung diseases that elevate the pulmonary pressure.

Answer 35

right side heart failure

Question 36

affect the intracellular calcium levels in the heart muscle, leading to increased contractility to improve the heart's ability to pump blood effectively.

Answer 36

cardiotonic agents or drugs

Question 37

increased contraction > increased cardiac output (amount of blood pump to the heart) > increased renal blood flow and urine production > decrease renin release > increase urine output > decreased blood volume

Question 38

increases intracellular calcium and allows more calcium to enter myocardial cells during depolarization

Answer 38

digoxin

Question 39

Increases intracellular calcium and allows more calcium to enter the myocardial cell during depolarization; this causes a positive inotropic effect (increased force of contraction), increased renal perfusion with a diuretic effect and decrease in renin release, a negative chronotropic effect (slower heart rate), and slowed conduction through the AV node.

Answer 39

digoxin

Question 40

belong to a second class of drugs that act as cardiotonic (inotropic) agents.

Answer 40

phosphodiesterase inhibitors

Question 41

the only phosphodiesterase inhibitors drugs that is currently available

Answer 41

milrinone

Question 42

block the enzyme phosphodiesterase and this blocking effect leads to an increase in myocardial cell cyclic adenosine monophosphate (cAMP), which increases calcium levels in the cell

Answer 42

phosphodiesterase inhibitors

Question 43

Short-term treatment of HF in patients who have not responded to digitalis, diuretics, or vasodilators

Answer 43

milrinone

Question 44

Blocks the enzyme phosphodiesterase, which leads to an increase in myocardial cell cAMP, which increases calcium levels in the cell, causing a stronger contraction and prolonged response to sympathetic stimulation; directly relaxes vascular smooth muscle.

Answer 44

milrinone

Question 45

does not affect muscle contraction but does affect the pacemaker (slows down) of the heart to reduce heart rate.

Answer 45

hyperpolarization activated nucleotide gated channel blockers

Question 46

Slowing the heart rate allows more time for ventricular filling and improves cardiac output

Question 47

Treatment of chronic heart failure in stable patients at maximum beta-blocker doses, to prevent rehospitalizations.

Answer 47

ivabradine

Question 48

increases the movement of calcium into the heart muscle. This results in increased force of contraction, which increases blood flow to the kidneys (causing a diuretic effect), slows the heart rate, and slows conduction through the AV node. All of these effects decrease the heart’s workload

Answer 48

cardiac glycoside (digoxin)

Question 49

block the breakdown of cAMP in the cardiac muscle. This allows more calcium to enter the cell (leading to more intense contraction) and increases the effects of sympathetic stimulation (which can lead to vasodilation but also can increase pulse, blood pressure, and workload on the heart)

Answer 49

phosphodiesterase inhibitors

Question 50

the only phosphodiesterase inhibitor available, is associated with severe effects. It is reserved for use in extreme situations. It is only available for IV use.

Answer 50

milrinone

Question 51

is the first HCN blocker, which is used with stable, chronic HF to slow the pacemaker of the heart, reducing heart rate without the systemic effects that occur with beta-blockers. Slowing the heart rate allows more time for ventricular filling and improves cardiac output without the systemic effects seen with beta-blockers

Answer 51

ivabradine

Question 53

is the functioning unit of the heart

Answer 53

sarcomere