Exam 1 - HF

Question 1

Structural or functional cardiac disorder that impairs the ability of ventricle to fill with or eject blood (disorder of impaired CO)

Answer 1

HF

Question 2

2 symptoms of HF:

Answer 2

Dyspnea

Fatigue

Question 3

2 signs of HF:

Answer 3

Edema

Rales

Question 4

Is there a diagnostic test for HF?

Answer 4

No

Question 5

Systolic dysfunction ventricular emptying; increased or decreased?

Answer 5

Decreased

Question 6

What does diastolic dysfunction heart look like?

Answer 6

Increased heart wall

Question 7

What 3 things occur with chronic use of Frank-Starling?

Answer 7

Sodium retention
Water retention
Venoconstriction

Question 8

When is sympathetic nervous system triggered?

Answer 8

Decrease in CO

Question 9

What does sympathetic nervous system activate?

Answer 9

RAAS

Question 10

What 3 things occur with activation of RAAS?

Answer 10

1. Water retention
2. Increased contractility
3. Vasoconstriction

Question 11

What does RAAS trigger?

Answer 11

Aldosterone

Question 12

Diagnosis of HR requires the simultaneous presence of what?

Answer 12

2 major criteria

1 major criterion with 2 minor criteria

Question 13

BNP >500 pg/ml

NT-proBNP >1800 pg/ml

Answer 13

Likely HF

Question 14

What 3 things do you have to rule out with somewhat elevated BNP?

Answer 14

1. Pulmonary embolism
2. Renal failure
3. Pulmonary HTN

Question 15

What stage: Patients at high risk for developing HF?

Answer 15

Stage A

Question 16

What stage: pts with structural heart disease but no HF s/s?

Answer 16

Stage B

Question 17

What stage: pts with structural heart disease and current or previous symptoms?

Answer 17

Stage C

Question 18

What stage: refractory HF requiring specialized interventions?

Answer 18

Stage D

Question 19

What stage examples: HTN, CAD, atherosclerosis, DM, obesity, metabolic syndrome

Answer 19

Stage A

Question 20

What stage examples: previous MI, LV hypertrophy, LV systolic dysfunction

Answer 20

Stage B

Question 21

What stage examples: LV systolic dysfunction and symptoms (dyspnea, fatigue, and reduced exercise tolerance)

Answer 21

Stage C

Question 22

What stage examples: pts with treatment refractory symptoms at rest despite max medical therapy

Answer 22

Stage D

Question 23

What class: no symptoms

Answer 23

Class 1

Question 24

What class: symptoms with moderate exertion

Answer 24

Class 2

Question 25

What class: symptoms with minimal exertion

Answer 25

Class 3

Question 26

What class: symptoms at rest

Answer 26

Class 4

Question 27

5 steps of treatment:

Answer 27

1. Establish Dx of HFrEF; assess volume, initiate GDMT 2. Consider scenario 3. Implement indicated GDMT 4. Reassess symptoms 5. Consider additional therapy

Question 28

Is metoprolol tartrate or carvedilol better for chronic HF?

Answer 28

Carvedilol

Question 29

What period with effects from BB: - negative inotropy - reduced HR - improved myocardial substrate utilization - some with increased signs of reduced CO - some with symptomatic relief

Answer 29

Days to weeks

Question 30

What period with effects from BB: - improvement in invasive and non invasive measurements of cardiac function - stabilization of clinical symptoms

Answer 30

Weeks to months

Question 31

What period with effects from BB: - improvement in clinical symptoms and possibly physical capacity - reduced risk of hospitalization and death

Answer 31

Months to 1yr

Question 32

How much do you increase BB dose?

Answer 32

50-100% every 2-4wks

Question 33

Decreases spontaneous pacemaker activity of SA node:

Answer 33

Ivabradine

Question 34

What does ivabradine do overall?

Answer 34

Slow HR

Question 35

What treatment to use with symptomatic HFrEF if HR >70 while on max BB?

Answer 35

Ivabradine

Question 36

3 adverse effects of ivabradine:

Answer 36

1. Bradycardia 2. Atrial fibrillation 3. Luminous phenomena

Question 37

What is recommended in pts with symptomatic HF and EF <40%?

Answer 37

ACE inhibitors

Question 38

Do you continue ACE inhibitors perioperatively in HF pts?

Answer 38

YES

Question 39

What is recommended in pts with HF and EF <40% that are intolerant to ACE inhibitors because of cough or angioedema?

Answer 39

ARB

Question 40

Do you continue ARBs perioperatively in HF pts?

Answer 40

YES

Question 41

What do you add to pts with background ACE-I and BB therapy in pts with symptomatic HF and EF <40%?

Answer 41

Aldosterone antagonist

Question 42

What are the 2 aldosterone antagonists?

Answer 42

Spironolactone | Eplerenone

Question 43

What 2 contraindications are for aldosterone antagonists?

Answer 43

1. Potassium >5 | 2. CrCl <30

Question 44

What drug: Venodilation and reductions in preload; increase in NO

Answer 44

Isosorbide dinitrate

Question 45

What drug: artieral dilation to reduce afterload and increase SV and CO; increase in NO

Answer 45

Hydralazine

Question 46

What attenuates myocardial remodeling and may play a protective role in HF?

Answer 46

NO

Question 47

What is recommended to be added on for black HF pts who remain symptomatic despite optimal medical therapy?

Answer 47

Hydralazine/isosorbide dinitrate

Question 48

First line therapy in all HF pts unable to tolerate either ACE-I or ARBs because of renal insufficiency, hyperkalemia, or hypotension?

Answer 48

Hydralazine/isosorbide dinitrate

Question 49

What drug for HF pts who have evidence of fluid retention?

Answer 49

Diuretics

Question 50

Which diuretic is better: loop or thiazide?

Answer 50

LOOP

Question 51

What type of diuresis: - dyspnea on exertion - increased lower extremity and abdominal swelling - increased wt

Answer 51

Under

Question 52

What type of diuresis: - blood urea nitrogen increased to 61 - serum creatinine increased to 2.5 - orthostatic BP changes with standing

Answer 52

Over

Question 53

What drug increases parasympathetic activity?

Answer 53

Digoxin

Question 54

What drug - increases CI - decreases preload with little effect on BP

Answer 54

Digoxin

Question 55

Does digoxin have a narrow therapeutic range | Women, older pts, pts with impaired renal function

Answer 55

YES

Question 56

What is indicated in pts who have symptomatic HF, LVEF <35%, and widened QRS complex?

Answer 56

Cardiac resychronization therapy (CRT)

Question 57

Is there any evidence-based treatment for HFpEF?

Answer 57

NO

Question 58

Rapid onset or change in s/s of HF, resulting in need of urgent therapy

Answer 58

Acute HF

Question 59

What does acute HF look like on graph?

Answer 59

Upward slopes gradually going down

Question 60

Main medical management for AHFS?

Answer 60

Based on precipitating factors and clinical presentation

Question 61

What should be started with warm and wet AHFS?

Answer 61

Loop diuretics

Question 62

Warm and wet AHFS in pts with fluid overload in a sense of systemic hypotension, what should be used?

Answer 62

Nitroglycerin | Nitroprusside

Question 63

Effect of HF treatment should be monitored with measurement of what 4 things?

Answer 63

1. Fluid intake and output 2. Vital signs 3. Body wt 4. Perfusion and congestion

Question 64

Cold and wet AHFS in pts, what drugs should be used? (4)

Answer 64

1. Dopamine 2. Dobutamine 3. Milrinone 4. NorE

Question 65

What 4 things do you monitor intraoperative?

Answer 65

1. Intraarterial P 2. Pulmonary artery catheter 3. TEE 4. Esophageal Doppler monitor