Heart Failure

Question 1

index for preload

Answer 1

End diastolic volume (influenced by chamber compliance

Question 2

HF with reduced ejection fraction is due to ___ dysfunction

Answer 2

systolic

Question 3

cor pulmonale

Answer 3

right sided failure that results from primary pulmonary process

Question 4

right sided failure is suceptible to failure with sudden _____

Answer 4

increase in afterload

Question 5

right sided heart failure, RV has ___ compliance

Answer 5

high

Question 6

2 mechanisms of compensation for heart failure

Answer 6

frank starling increase in VEDV

hypertorphy

Question 7

negative consequences of renin-angiotensin activation

Answer 7

increase in afterload and fluid retention

Question 8

sympathetic stim increases ___ to maintain organ perfusion

Answer 8

vasoconstriction

Question 9

presentation symptoms of left sided failure

Answer 9

dyspenea

orthopnea

paroxysmal nocturnal pyspnea

fatigue

Question 10

physical exam left sided failure

Answer 10

diaphoresis

tachy

pulmonary rales

loud P2 (s3 gallop in systolic dsfxn, s4 for diastolic)

Question 11

presentation right sided failure

Answer 11

peripheral edma

right upper quadrant discomfort (liver enlargement)

Question 12

physical exam right sided failure

Answer 12

jugular venous distention

hepatomegaly

peripheral edema

Question 13

Digoxin therapuetic effects

Answer 13

positive ionotrope

increases vagal tone to slow HR

arterial and venous dilation

normalized baroreceptors

Question 14

mechanism digoxin

Answer 14

inhibition of NaK ATPase - results in less drive to push Na out of Cell

results in increased levels of Ca in cells > contractility

Question 15

ECG finding of Digoxin use

Answer 15

increased PR interval (decreasted conduction velocity in AV node, reduced firing of SA node)

Question 16

pharmacokinetic digoxin

Answer 16

36 hour half life

oral

kidney excretion

Question 17

adverse effects Digoxin

Answer 17

GI,

Visual disturbances

Neuro - disorientation, hallucinations

Muscular weakness and fatigue

cardiac arrhythmias

hypokalemia

Question 18

indications DIgoxin

Answer 18

not first line

LV systolic dsfxn with AFib,

refactory pts in sinus rhythm

Question 19

indications B adrenergic agonists (dopamine dobutamine)

Answer 19

IV hemodynamic support for acutely ill (acute decompensated HF)

Question 20

indications phosphodiesterase inhibitors (milrinone)

Answer 20

limit IV for acute (decompensated HF)

positive inotrope and vasodilator

Question 21

therapuetic effects diuretics

Answer 21

reduce fluid volume > preload

reduced heart size

reduced edema

Question 22

loop diuretic, promotes K loss > hypokalemia

Answer 22

furosemide

Question 23

thiazide diuretic, in combo with loop diuertics, promotes k loss (hypokalemia)

Answer 23

clorothiazide

Question 24

weak diuretic activity, limited K and Mg wasting.

K sparing

Answer 24

amiloride, triamterene

Question 25

atrial dilator

Answer 25

hydralazine

Question 26

arterial vasodilator hydralazien therapuetic effect

Answer 26

reduced systemic resistance \> increased stroke volume

Question 27

\_\_\_ stimulates fibrosis in heart and vasculature, cardiac hypertrophy

Answer 27

aldosterone

Question 28

promotes sympathetic activation by increasing adreal medullary catecholamien release

Answer 28

angiotensin

Question 29

promotes myocardial hypertrophy and apoptosis

Answer 29

angiotensin

Question 30

ace inhibitors

Answer 30

Captopil lisinopril enalapril

Question 31

actions in heart failure, ACE inhibitors

Answer 31

Decrease systemic vascular resistenace (afterload) reduce preload reduce Na retention, cardiac fibrosis, hypertrohpy

Question 32

ACE Inhibitors may decrease ___ function, particularly in HF patients

Answer 32

renal function

Question 33

with ACE inhibitors, ___ may develop, esp if used with aldosterone angtonist

Answer 33

hyperkalemia

Question 34

angiotensin R1 blocker

Answer 34

Losarton

Question 35

indications, losartan

Answer 35

alternative to ACE inhibitors (avoids problematic side effects by not impacting bradykinin)

Question 36

ACE inhibitor Adverse effects

Answer 36

Hyperkalemia angioedema hypotension dry cough

Question 37

angioedema, dry cough, and other side effects of ACE inhibitors due to

Answer 37

reduction of bradykinin breakdown

Question 38

veno dilator and arterial dilator combination

Answer 38

isosorbide dinatrate and hydralzine

Question 39

aldosterone antagonists

Answer 39

spironolactone, eplerenone

Question 40

therapeutic effects spironolactone, eplerenone

Answer 40

reduced edema (renal effects) decrease fibrosis in myocardium and vessels\_

Question 41

therapeutic effects Beta blockers

Answer 41

decrease arrythmias decrease O demand, decrease BP prevent disease progression

Question 42

proven effective B blockers

Answer 42

carvedilol, metoprolol, bisoprolol

Question 43

Furosemide Improve symptoms? Decrease mortality? Prevent CHF? Neurohormonal Control?

Answer 43

yes ? ? ?

Question 44

digoxin ## Footnote Improve symptoms? Decrease mortality? Prevent CHF? Neurohormonal Control?

Answer 44

yes no minimal yes

Question 45

inotropes ## Footnote Improve symptoms? Decrease mortality? Prevent CHF? Neurohormonal Control?

Answer 45

yes increase mortality ? no

Question 46

beta blockers ## Footnote Improve symptoms? Decrease mortality? Prevent CHF? Neurohormonal Control?

Answer 46

yes yes yes yes

Question 47

ACE inhibitors Improve symptoms? Decrease mortality? Prevent CHF? Neurohormonal Control?

Answer 47

yes yes yes yes

Question 48

spironolactone Improve symptoms? Decrease mortality? Prevent CHF? Neurohormonal Control?

Answer 48

yes yes yes yes