Lecture 12: Heart Failure - Part 2

Question 1

What is a non-pharmacologic approach to tx of HF if pt’s Na⁺ is <126 mEq/L?

Answer 1

Fluid restriction to <2 L/day

Question 2

Which type of activity should be avoided in HF and what should be encouraged?

Answer 2

• AVOID isometric acivity which ↑ SVR and afterload
• ENCOURAGE isotonic activity - walking, hiking, golf

Question 3

Why is enoxaparin (subcut lovenox) given to someone with HF?

Answer 3

Prophylaxis for DVT’s

Question 4

What does a class II recommendation mean in evidence based medicine?

Answer 4

Conflicting evidence and/or divergence of opinion

Question 5

What does a grade of A-C represent in levels of evidence for evidence based recommendations?

Answer 5

• A = data from meta-analysis or multiple RCT’s; multiple populations evaluated
• B = data from single RCT or non-randomized studies; limited population evaluated
• C = only consensus opinion of experts, case studies, or standard of care, very limited populations evaluated

Question 6

Which drug class is useful for all NYHA functional classification with systolic HF?

Answer 6

ACE inhibitors

Question 7

ACE-I should be used cautiously in pt’s with what 2 underlying conditions?

Answer 7

• Renal insufficiency
• K+ >5 mEq/L

Question 8

You should not give an ARB to a pt that had what AE from an ACE-I?

Answer 8

Angioedema

Question 9

There is a survival benefit with using beta-blockers with what 2 underlying heart conditions?

Answer 9

• Chronic systolic HF
• Dilated cardiomyopathy

Question 10

Beta-blockers should never be used in pt’s who are in what classification of HF?

Answer 10

Unstable (Class IV)

Question 11

Which NYHA functional classes of HF are beta-blockers recommended in?

Answer 11

Class II and III

Question 12

The US Carvedilol HF program showed improvement in what 2 pt parameters?

Answer 12

• Improved LVEF
• Improved well being

Question 13

Which level of evidence exists for the use of beta-blockers in all stable pt’s with sx’s of HF and reduced EF, unless contraindicated?

Answer 13

Level A

Question 14

Diuretics are able to relieve congestive (pulmonary) sx’s by decreasing what?

Answer 14

Preload

Question 15

Which inotropic agent is useful in HFrEF and A.fib for ventricular rate control?

Answer 15

Digitalis

Question 16

Which level of evidence exists for the use of Spironolactone in decreasing mortaility and decreasing HF hospitalization?

Answer 16

Level B

Question 17

Which drug used in HF is an inotropic vasodilator?

Answer 17

Milrinone = PDE inhibitor

Question 18

Which inotropic agent used in HF stimulates beta-1 receptors and is useful short-term?

Answer 18

Dopamine

Question 19

Which drug given for HF is an arterial vasodilator, which reduced afterload and SVR?

Answer 19

Hydralazine

Question 20

When is hydralazine plus isosorbide dinitrate used for HF?

Answer 20

• Better response in African Americans
• Can be used in general if intolerant to ACE-I/ARB