drugs for CHF, angina, arrhythmias

Question 1

What is the fundamental problem in CHF?

Answer 1

The heart cannot pump enough blood to meet the body’s oxygen needs.

Question 2

How is cardiac output (CO) calculated?

Answer 2

CO = Heart Rate × Stroke Volume

Question 2

What characterizes left-sided heart failure?

Answer 2

Weakened contraction, reduced ejection fraction, lung congestion, respiratory issues.

Question 3

What characterizes right-sided heart failure?

Answer 3

Inability to pump blood to the lungs, severe peripheral edema.

Question 4

What causes angina?

Answer 4

Insufficient oxygen supply to the heart, leading to ischemia and hypoxia.

Question 5

Why does angina cause pain?

Answer 5

Anaerobic metabolism increases lactic acid, causing a burning sensation.

Question 6

What is an arrhythmia?

Answer 6

Disruption in normal heart rhythm.

Question 6

What is the pathway of blood through the heart?

Answer 6

Veins → Right atrium → Right ventricle → Lungs → Left atrium → Left ventricle → Body

Question 7

What is the function of the right side of the heart?

Answer 7

Pumps blood to the lungs for oxygenation.

Question 8

What is the function of the left side of the heart?

Answer 8

Pumps oxygenated blood to the body.

Question 9

What is preload?

Answer 9

The amount of blood filling the ventricles before contraction.

Question 10

What is afterload?

Answer 10

The pressure the heart must overcome to eject blood.

Question 11

What happens in left-sided heart failure?

Answer 11

The left ventricle weakens, leading to pulmonary congestion and fluid buildup in the lungs.

Question 12

What are symptoms of left-sided heart failure?

Answer 12

Shortness of breath, coughing, wheezing, pulmonary edema.

Question 13

What happens in right-sided heart failure?

Answer 13

The right ventricle can’t pump blood effectively to the lungs, causing blood to back up in veins.

Question 14

What are symptoms of right-sided heart failure?

Answer 14

Peripheral edema, swelling in legs and ankles.

Question 15

How does the body respond to heart failure?

Answer 15

Activates the renin-angiotensin-aldosterone system (RAAS).

Question 16

Why can RAAS activation worsen heart failure?

Answer 16

Increases blood volume, raises blood pressure, and adds strain on the heart.

Question 17

What does the renin-angiotensin-aldosterone system (RAAS) do in heart failure?

Answer 17

Increases angiotensin, aldosterone, blood volume, and sympathetic activity.

Question 18

How does increased blood volume worsen heart failure?

Answer 18

Adds pressure on the heart, increases preload, and causes fluid retention (edema).

Question 19

How does angiotensin II affect heart failure?

Answer 19

Causes vasoconstriction, making the heart pump against higher resistance (increased afterload).

Question 20

How does the sympathetic nervous system react to heart failure?

Answer 20

Increases heart rate, contractility, cardiac output, and blood pressure.
Further activates RAAS, increasing fluid retention and stress on the heart.

Question 21

Why is increased heart rate (HR) bad for heart failure?

Answer 21

Raises oxygen demand while the heart is already weak.

Question 22

How do ACE inhibitors & ARBs help heart failure?

Answer 22

Reduce vasoconstriction (↓ afterload), blood volume (↓ preload), and sympathetic output, fluid retention.

Question 23

Why do beta blockers help, despite initially seeming counterintuitive?

Answer 23

Reduce RAAS activation, lower heart rate - sympathetic output, and block harmful catecholamine effects.

Question 24

How does cardiac glycosides lead to stronger heart contractions?

Answer 24

Blocks sodium pump in heart cells → sodium builds up inside cells → High sodium leads to calcium buildup → makes heart contract stronger

Question 24

How do cardiac glycosides like digoxin work?

Answer 24

Block Na+/K+ ATPase pump, increasing intracellular sodium.

Question 25

What are the main benefits of digoxin?

Answer 25

Stronger heart contractions, better blood circulation, and symptom relief.

Question 26

What are the main risks of digoxin?

Answer 26

small therapeutic index—to little doesn't help to much is toxic (cns side effect) little long term benefits many drug interactions

Question 27

What triggers stable angina?

Answer 27

Physical exertion or stress (increased oxygen demand).

Question 28

When does vasospastic angina occur?

Answer 28

At rest, unpredictably, not triggered by exertion.

Question 29

What causes stable angina?

Answer 29

Atherosclerotic narrowing of coronary arteries.

Question 29

How long do symptoms of stable angina last?

Answer 29

A few minutes, relieved by rest.

Question 30

What causes vasospastic angina?

Answer 30

Coronary artery spasms (not necessarily atherosclerosis).

Question 31

How is vasospastic angina different from stable angina?

Answer 31

It’s caused by arterial spasms, not physical activity.

Question 32

What causes unstable angina?

Answer 32

Platelet plugs forming in coronary arteries.

Question 33

Why is unstable angina more dangerous than stable angina?

Answer 33

It signals worsening coronary artery disease and risk of a heart attack.

Question 34

How is unstable angina different from a heart attack?

Answer 34

Blood flow is reduced but not completely blocked.

Question 35

Can unstable angina occur at rest?

Answer 35

Yes, it is unpredictable and occurs without exertion.

Question 36

Which drugs increase coronary blood flow?

Answer 36

Organic nitrates (nitroglycerin) & DHP calcium channel blockers (amlodipine).

Question 37

How do organic nitrates help with angina?

Answer 37

Dilate coronary arteries, improving oxygen supply.

Question 38

What is the role of DHP calcium channel blockers (e.g., amlodipine)?

Answer 38

Dilate coronary arteries and increase blood flow for chronic angina prevention.

Question 38

When are organic nitrates most useful?

Answer 38

For acute angina attacks (rapid relief, especially sublingual nitroglycerin).

Question 39

Which drug classes reduce heart workload?

Answer 39

Beta blockers, non-DHP calcium channel blockers, and nitrates.

Question 40

How do beta blockers help with angina?

Answer 40

Slow heart rate and reduce contractility, lowering oxygen demand.

Question 41

Why aren’t beta blockers useful for acute attacks?

Answer 41

They act too slowly to provide immediate relief.

Question 42

Which calcium channel blockers work like beta blockers?

Answer 42

Non-DHP calcium channel blockers (verapamil, diltiazem).

Question 43

How do nitrates help reduce cardiac workload?

Answer 43

Dilate veins (reducing preload) and lower blood pressure (reducing afterload).

Question 44

Why is sublingual nitroglycerin preferred for acute angina?

Answer 44

Works within minutes, provides fast relief, and has a short duration (15–30 min).

Question 45

How does nitroglycerin work?

Answer 45

Releases nitric oxide (NO), causing vasodilation, increase blood flow, reducing heart workload.

Question 46

Which drugs interact dangerously with nitrates?

Answer 46

PDE5 inhibitors (Viagra, Cialis, Levitra). erticle dysfunction medicatoins

Question 47

Why should patients sit when taking nitroglycerin?

Answer 47

Prevents fainting due to sudden blood pressure drop.

Question 48

Why is the combination of nitrates and ED meds dangerous?

Answer 48

Causes excessive vasodilation, leading to severe hypotension and fainting.

Question 48

What is the mechanism behind this dangerous interaction?

Answer 48

Nitrates increase NO, while PDE5 inhibitors prevent cGMP breakdown—together, they cause extreme blood vessel dilation.

Question 49

Where does the electrical signal originate in the heart?

Answer 49

SA (Sinoatrial) Node, the natural pacemaker (60–100 bpm).

Question 50

What does the P wave on an ECG represent?

Answer 50

* Small upward bump * Represents atria depolarizing * First electrical activity in cycle * Shows SA node started the beat correctly

Question 51

What is the role of the AV (Atrioventricular) Node?

Answer 51

Delays the signal, allowing the atria to fully contract before ventricles.

Question 52

Which part of the ECG represents ventricular depolarization?

Answer 52

The QRS complex.

Question 53

How does the signal spread through the ventricles?

Answer 53

Via Purkinje fibers, causing ventricular contraction.

Question 54

What does the T wave represent on an ECG?

Answer 54

Ventricular repolarization (resetting for the next beat).

Question 55

What are the characteristics of a normal sinus rhythm (NSR)?

Answer 55

Rate: 60–100 bpm Each P wave followed by a QRS complex Regular, evenly spaced beats Clear return to baseline between cycles

Question 56

Sodium Channel Blockers Example drug?

Answer 56

Lidocaine

Question 57

Sodium Channel Blockers Acts on atrial or ventricular arrhythmias?

Answer 57

Ventricular

Question 58

Beta Blockers Example drug?

Answer 58

Propranolol

Question 58

Sodium Channel Blockers Main use?

Answer 58

Ventricular fibrillation

Question 59

Sodium Channel Blockers Effect on cardiac action potential?

Answer 59

Slows rate of depolarization (Phase 0)

Question 60

Beta Blockers Effect on heart function?

Answer 60

Slows heart rate & AV conduction

Question 60

Beta Blockers Acts on atrial or ventricular arrhythmias?

Answer 60

Atrial (supraventricular)

Question 61

Beta Blockers Main use?

Answer 61

Supraventricular tachycardia (SVT)

Question 62

Potassium Channel Blockers Acts on atrial or ventricular arrhythmias?

Answer 62

Ventricular

Question 62

Potassium Channel Blockers Example drug?

Answer 62

Amiodarone

Question 63

Potassium Channel Blockers Main use?

Answer 63

Ventricular fibrillation

Question 64

Potassium Channel Blockers Effect on cardiac action potential?

Answer 64

Prolongs repolarization (Phase 3)

Question 65

Calcium Channel Blockers (CCBs) Main use?

Answer 65

Supraventricular tachycardia (SVT)

Question 65

Calcium Channel Blockers (CCBs) Acts on atrial or ventricular arrhythmias?

Answer 65

Atrial (supraventricular)

Question 65

Calcium Channel Blockers (CCBs) Example drugs?

Answer 65

Verapamil, Diltiazem

Question 65

Calcium Channel Blockers (CCBs) Effect on heart function?

Answer 65

Slows heart rate & AV conduction

Question 66

Atrial problems are more likely to use which classes?

Answer 66

Class 2 & 4

Question 66

Ventricular problems are more likely to use which classes?

Answer 66

Class 1 & 3