Congestive Heart Failure

Question 1

What is Congestive heart failure

Answer 1

Inability of the heart to pump sufficient blood

Question 2

What causes cardiac remodelling

Answer 2

Ischemia
Excessive workload
Angiotensin 2
Aldosterone

Question 3

What drugs decreases cardiac remodelling

Answer 3

RAAS inhibitors 
ACE inhibitors 
Angiotensin 2 receptor blocker 
Aldosterone receptor antagonist 
B blockers

Question 4

ACE inhibitors mechanism of action

Answer 4

• prils
• Block angiotensin converting enzyme, decrease plasma angiotensin 2
• decrease vasoconstriction, decrease NA+ and H2O retention
• increase bradykinin

Question 5

ACE inhibitors indications

Answer 5

Chronic HF

Hypertension (primary and secondary causes by DM)

Question 6

What happens due to Increase in Bradykinin

Answer 6

It causes dry cough and angioedema

-vasodilation and increase in NO

Question 7

ACE inhibitors adverse effects

Answer 7

Teratogenic, dry cough, angioedema and hyperkalemia

Question 8

Which ace inhibitors are not metabolised by the liver

Answer 8

Captopril and lisinopril

Question 9

ACE inhibitors contraindications

Answer 9

Pregnancy
Allergy
Dry cough 
Renal insufficiency 
Bilateral renal artery stenosis

Question 10

What causes angiotensin escape

Answer 10

Chumash TPA cathepsin

Question 11

How should ACE inhibitors be dowsed

Answer 11

ACE I should be started at low doses and titrated to target dose

Question 12

How often is AT blockers administered

Answer 12

Once daily except for valsartan twice daily

Question 13

Which of the ARBs/ AT blockers is transferred in to active metabolites

Answer 13

Losartan

Question 14

When and why are ARBs used

Answer 14

When ACE side effects can’t be tolerated because there is no blockade of bradykinin degradation there won’t be dry cough m

Question 15

Why shouldn’t arbs and ace be used together

Answer 15

Increased risk of hypotension, hyperkalemia and renal dysfunction

Question 16

List the aldosterone antagonists used for CHF

Answer 16

Spirinolactone and eplerenone

Question 17

Why are aldosterone antagonists used in CHF

Answer 17

Aldosterone receptors on the heart can lead to cardiac hypertrophy and fibrosis (remodelling)

Question 18

List B blockers used in CHF

Answer 18

Bisoprolol
Carvedilol
Metoprolol succinate

Question 19

How is B blocker doses

Answer 19

Start at low dose and titrated up

The starting dose is 10% of target dose

Question 20

What are the benefits of giving B blockers to people with CHF

Answer 20

Increase survival of myocytes and left ventricular structure and function
Also decrease renin

Question 21

What should be monitored giving B blockers

Answer 21

BP
HR
EKG

Question 22

What is recommended for patients with stable symptomatic HFrEF (heart failure with increased ejection fraction)

Answer 22

ACE I and B blocker

Question 23

Why are diuretics given in CHF

Answer 23

Decrease in plasma volume leads to decrease in preload and after load

Question 24

Which diuretics are preferred in CHF

Answer 24

Loop diuretics

Question 25

When to discontinue diuretics in CHF patients

Answer 25

Hypovolemic patient

Question 26

Ionotropic drugs mechanism of action

Answer 26

Increase Ca2+ in cardiac muscle cells which leads to increase in contractility and increase in cardiac output in

Question 27

Digoxin mechanism of action

Answer 27

Block Na+/K+ ATPase -> increase of intracellular Na+ ->increase in Ca2+ leading to ionotropic effect

Question 28

Digoxin half life

Answer 28

36 hours

Question 29

What should be monitored when digoxin is given

Answer 29

K+

Question 30

What effects does digoxin have other than on the heart

Answer 30

It overstimulates of sympathetic system causes stimulation of the vagus nerve which increases the renal blood flow that leads to diuresis

Question 31

Digoxin indications

Answer 31

CHF, atrial flutter and fibrillation

Question 32

Digoxin adverse effects

Answer 32

Blurred vision m, CNS symptoms, cardiac toxicity (heart block)

Question 33

Treatment of digoxin toxicity

Answer 33

Lidocaine and propanol

Question 34

What are PDE I

Answer 34

Mil iron one is a PDE inhibitor it causes increase in CAMP that lead to increase in intracellular Ca2+

Question 35

Which drugs of CHF can be given in our patient settings

Answer 35

Milieu one and dobutamine

Question 36

Which cardio vascular drug causes xanthopsia, blurred vision, yellowish vision

Answer 36

Digoxin

Question 37

Which cardiovascular drug that causes visual disturbances like luminous phenomena

Answer 37

Ivabradine

Question 38

Which cardiovascular drug causes impairment of blue green colour discrimination

Answer 38

Sildenafil

Question 39

What should ivabradine be taken with

Answer 39

With meals

Question 40

Ivabradine mechanism of action

Answer 40

- Selectively binds to funny channels HCN channel (mixed Na+ -K+ current) - inhibiting pacemaker current in SA node leading to decrease in heart rate

Question 41

What is ivabradine used for

Answer 41

Used for sinus rhythm

Question 42

List Vasodilators of CHF

Answer 42

Hydralazine- direct dilatory action on smooth muscle cells

Question 43

Hydralazine effect

Answer 43

Decrease systolic and diastolic blood pressure | Increase renin activity

Question 44

List venodilators

Answer 44

Isosorbide dinitrate that is used for angina pectoris

Question 45

What is H-ISDN

Answer 45

Hydralazine + Isosorbide dinitrate

Question 46

When is H-ISDN given

Answer 46

It is given to African American patients who continue to have HF symptoms even with optimal doses of ACE-I and B- Blocker

Question 47

What is the other option other than H-ISDN given to patients who continue to have heart failure symptoms

Answer 47

Replace ACE I with Sacubitril/valsartan