Heart Failure

Question 1

NYHA Class I and ACC/AHA Stage B

Answer 1

Patients with cardiac disease but without physical activity limitations. Ordinary physical activity does not cause symptoms.

Question 2

NYHA Class II and ACC/AHA Stage C

Answer 2

Patients with cardiac disease and have mild physical activity limitations. Ordinary physical activity causes symptoms.

Question 3

NYHA Class III and ACC/AHA Stage C

Answer 3

Patients with cardiac disease and have marked physical activity limitations. They are comfortable at rest but ordinary activity causes symptoms.

Question 4

NYHA Class IV and ACC/AHA Stage C,D

Answer 4

Patients with cardiac disease and has discomfort with any physical activity. There are symptoms at rest.

Question 5

ACC/AHA Stage A

Answer 5

Patients that are at high risk for heart failure.

Question 6

ACC/AHA Stage A Meds

Answer 6

• anti-HTN meds and statins

- ACE Inhibitors

Question 7

ACC/AHA Stage B Meds

Answer 7

• ACE Inhibitors, ARBs

- Beta blockers

Question 8

ACC/AHA Stage C Meds

Answer 8

• diuretics
• ACE Is, ARBS
• Beta blockers
• Aldosterone receptor antagonists

Question 9

ACC/AHA Stage D Meds

Answer 9

• Continuous IV therapy

- chronic oral meds if at stage 3

Question 10

Advantage of ACE Is in HF

Answer 10

• improves symptoms
• improves exercise tolerance
• improves QOL
• improves LV size and function
• reduces hospitalizations
• reduces mortality
• prevents HF development in high risk patients

Question 11

Advantage of ARBs in HF

Answer 11

• reduces hospitalizations, sudden cardiac death, and all causes of mortality

Question 12

ACE Is/ARBs Absolute Contraindications

Answer 12

• pregnancy
• angioedema
• bilateral renal artery stenosis

Question 13

ACE Is/ARBs Relative Contraindications

Answer 13

• unilateral renal artery stenosis
• renal insufficiency
• hypotension
• hyperkalemia
• cough

Question 14

New ACE Is/ARBs in HF

Answer 14

• Sacubitril

- Valsartan

Question 15

Hydralazine and Isosorbide Dinitrate AEs

Answer 15

• hypotension
• headache
• tachycardia
• Lupus

Question 16

Hydralazine and Isosorbide Dinitrate Not to Be Used with…

Answer 16

• Sildenafil
• Tadalafil
• Vardenafil

Question 17

Beta Blockers MOA

Answer 17

• block SNS (NE) at beta adrenergic receptors

Question 18

Advantage of Beta Blockers in HF

Answer 18

• reduces ventricular remodeling
• improves ventricular shape
• reduces LV end systolic and diastolic volumes
• improves ejection fraction
• reduces all cause and HF hospitalizations
• may decrease all cause mortality in HF

Question 19

Beta Blocker Dosing

Answer 19

• initiate at a low dose
• titrate slowly
• may cause short-term worsening of HF symptoms

Question 20

Beta Blocker Meds in HF

Answer 20

• carvedilol
• bisoprolol
• metoprolol

Question 21

Digoxin MOA

Answer 21

• binds to Na+ and K+ ATP pumps leading to increased intracellular Na+ concentrations
• regulates HR
• restores baroreceptor sensitivity and reduced sympathetic outflow (neurohormonal modulation)

Question 22

When to Use Digoxin

Answer 22

• with AFib– to slow HR

- for symptomatic patients despite optimized ACE I, Beta blocker and diuretic use

Question 23

Digoxin Toxicity Symptoms

Answer 23

• fatigue
• weakness
• CNS effects
• nausea, vomiting, anorexia
• visual disturbances
• ventricular tachycardia/fibrillation, AV node block, sinus bradycardia

Question 24

Digoxin Monitoring

Answer 24

• K+

- Mg++

Question 25

CCBs & HF

Answer 25

worsens HF and may increase risk of death (especially non-dihydropyridines

Question 26

Preserved (Diastolic) HF Therapies

Answer 26

- diuretics - beta blockers - CCBs - digoxin - ACE I/ARBs

Question 27

Acute HF Treatment

Answer 27

- vasodilators for congestion (nitroglycerin, nitroprusside, nesiritide) - intropic agents for hypoperfusion (dobutamine, dopamine, milrinone)