Heart Failure

Question 1

two ways that someone dies from HF

Answer 1

arrhythmia or pump failure

Question 2

HFrEF impairment on cardiac function

Answer 2

systolic dysfunction, decreased contractility

Question 3

HFrEF ejection fraction

Answer 3

EF<40% w symptoms

Question 4

HFrEF main cause

Answer 4

CAD

Question 5

HFpEF impairment on cardiac function

Answer 5

diastolic dysfunction, impairment on ventricle filling/relaxing

Question 6

HFpEF ejection fraction

Answer 6

EF >50% w symptoms

Question 7

HFmrEF

Answer 7

mildly reduced 41-49%

Question 8

HFimpEF

Answer 8

improved >40% but previously HFrEF

Question 9

preload

Answer 9

venous return, LV end diastolic volume

Question 10

afterload

Answer 10

wall stress

Question 11

drugs to reduce preload

Answer 11

SGLT2, diuretics

Question 12

drugs to reduce afterload

Answer 12

ACE, ARB, ARNI, SGLT2, vasodilators

Question 13

drug classes that induce HF

Answer 13

positive inotropes, cardiotoxins, sodium/water retention

Question 14

positive inotropes that induce HF

Answer 14

beta blockers, antiarrhythmics, CCB (dilt, verap), itraconzole

Question 15

direct cardiac toxins that induce HF

Answer 15

doxorubicin, epirubicin, daunomycin, -ibs, ethanol, cocaine, amphetamines, blue cohosh

Question 16

sodium load/water retention drugs that induce HF

Answer 16

glucocorticoids, androgens, estrogens, NSAIDs, cox2 inhibitors, -glitazone, sodium containing drugs

Question 17

signs / symptoms pulmonary congestion (wet)

Answer 17

exertional dysopnea (DOE), orthopnea, paroxysymal nocturnal dyspnea (PND), bendopnea, rales, pulmonary edema

Question 18

NYHA Class I

Answer 18

cardiac disease without limitations of physical activity

Question 19

NYHA Class II

Answer 19

cardiac disease with slight limitations of physical activity

Question 20

NYHA Class III

Answer 20

cardiac disease with limitations of physical activity

Question 21

NYHA Class IV

Answer 21

cardiac disease with inability to cary on physical activity without discomfort

Question 22

AHA Stage A

Answer 22

High risk developing HF (HTN, CAD, DM)

Question 23

AHA Stage B

Answer 23

structural heart disease but no HF sx (fibrosis, MI hx)

Question 24

AHA Stage C

Answer 24

HF symptoms or prior

Question 25

AHA Stage D

Answer 25

advanced structural heart disease and symptoms at rest despite max therapy

Question 26

Stage A therapy

Answer 26

ACE/ARB

Question 27

Stage B therapy

Answer 27

ACE/ARB, beta blocker

Question 28

Stage C therapy

Answer 28

ARNI/ACE/ARB beta blocker SGLT2 MRA loop diuretic for volume overload

Question 29

do diuretics reduce mortality?

Answer 29

no

Question 30

who should receive loop diuretics?

Answer 30

if experiencing volume overload, want lowest dose possible

Question 31

MOA loop diuretics

Answer 31

increase sodium and water excretion by reducing absorption at ascending limb

Question 32

loop diuretics release ____ which _____

Answer 32

prostaglandins, increase renal blood flow

Question 33

loop diuretics are blocked by what

Answer 33

NSAIDS

Question 34

thiazide diuretics moa

Answer 34

block Na and Cl reabsorption in DCT

Question 35

used in combo with loop in pts resistant to single drug therapy

Answer 35

hydrochlorothiazide and metolazone

Question 36

adverse effects diuretics

Answer 36

decrease Mg, K+, Na+, increase uric acid

Question 37

if fluid overload want to reduce weight:

Answer 37

1-2 lbs/day

Question 38

when do we need electrolyte replacement?

Answer 38

K < 4 Mg < 2

Question 39

ACE inhibitors cautions for adding

Answer 39

SBP < 80, K >5, SeCr >3

Question 40

what SeCr rise is acceptable?

Answer 40

less than or equal to 30%

Question 41

adverse effects ACE

Answer 41

hypotension, renal issues, hyperkalemia, skin rash, cough, angioedema

Question 42

sacubitril/valsartan MOA

Answer 42

inhibits degraedation of BNP by inhibiting neprilysin, blocks AT1 receptos

Question 43

enalapril __ = captopril ___ = lisinopril ___

Answer 43

enalapril 20 = capto 150 = lisinopril 20-40 high dose ACE

Question 44

high dose ACE equivalent dose of entresto

Answer 44

49/51 BID max: 97/103 BID

Question 45

low to medium dose ACE eGFR <30 age > 75 ACE naive

Answer 45

24/26 BID

Question 46

how long to wait after ACE use before taking ARB

Answer 46

36 hours

Question 47

should stage b, no sx get ARNI?

Answer 47

no

Question 48

beta blockers benefits HF

Answer 48

decrease arrhythmias, cardiac remodeling

Question 49

dose conversion carvedilol to Coreg CR

Answer 49

3.125 BID = 10 mg daily 6.25 BID = 20 mg daily 12.5 BID = 40 mg daily 25 BID = 80 daily

Question 50

effects of aldoseterone

Answer 50

sympathetic activation parasympathetic inhibition vascular remodeling

Question 51

MRA effects

Answer 51

decrease K and Mg losses decrease sympathetic simulation blocks fibrotic action on myocardium

Question 52

avoid MRAs with what labs

Answer 52

CrCl<30 or K>5

Question 53

avoid MRAs with what drugs

Answer 53

NSAIDS

Question 54

SGLT2s eGFR

Answer 54

dapagliflozin > 30 empagliflozin > 20

Question 55

BiDil pts to use

Answer 55

african americans needing additional therapy pts who cant receive ACE/ARB/ARNI

Question 56

Ivabradine use

Answer 56

pts with HR >70 on max beta blocker dose

Question 57

ivabradine side effects

Answer 57

fetal toxicity, afib, bradycardia

Question 58

digoxin effects

Answer 58

increase parasympathetic activity inhibits Na/K ATPase

Question 59

goal serum digoxin conc

Answer 59

0.5-0.9 ng/mL

Question 60

drug interactions with dig

Answer 60

amiodarone (doubles dig) quinadine verapamil itra and ketoconazole (doubles dig)

Question 61

what to do when taking amiodarone

Answer 61

deecrease dig dose 50%

Question 62

side effects digoxin

Answer 62

visual disturbances, anorexia, fatigue, N/V, AV block, bradycardia

Question 63

which drugs should not be used

Answer 63

diltiazem, verapamil, nifedipine

Question 64

HFpEF drugs

Answer 64

SGLT2 and diuretics mainly ACE - they don't reduce mortality

Question 65

acute decomp HF diagnosis

Answer 65

BNP >400, altered mental status, cold extremeties, worsening renal function,

Question 66

should you stop beta blockers in decomp hf

Answer 66

no unless recent initation led to the decomp hold if dobutamine needed do not add/up titrate

Question 67

which therapy of decomp HF reduces mortality

Answer 67

none

Question 68

warm and dry treatment

Answer 68

optimize chronic therapy

Question 69

warm and wet treatment

Answer 69

IV diuretics / IV vasodilator

Question 70

cold and dry treatment

Answer 70

SBP > 90 inotrope SBP < 90 inotrope or arterial vasodilator

Question 71

cold and wet

Answer 71

IV diuretics SBP < 90 inotrope SBP > 90 arterial vasodilator

Question 72

acute decomp inital IV diuretic dose should

Answer 72

match or exceed chronic dialy dose given as bolus

Question 73

vasodilators used for which

Answer 73

wet, considered over inotropes

Question 74

who should not get vasodilators

Answer 74

symptomatic hypotension

Question 75

nitroprusside

Answer 75

balanced vasodilator HTN crisis cyanide and thiacynanite toxicity

Question 76

nitroglycerin

Answer 76

verous preferred vasodilator ACS and HTN crisis

Question 77

nesiritide

Answer 77

balanced vasodilation

Question 78

vasodilator drugs

Answer 78

nitroprusside, nitroglycerin, nesiritide, morphine, enalaprilat, hydralazine

Question 79

positive inotrope drugs

Answer 79

dobutamine, dopamine, milrinone

Question 80

dobutamine

Answer 80

stimulates adenylcyclase to increase cAMP consider if low BP

Question 81

milrinone

Answer 81

PDE inhibitor venous > arterial vasodilation consider if on beta blocker or high SVR

Question 82

inotropes are for which pts

Answer 82

cold

Question 83

dopamine

Answer 83

vasopressor secondary role to dobutamine/milrinone