Path phys of HF Puri

Question 1

What is heart failure

Answer 1

inability for heart to meet requirements of the periphery without excessive filling pressure

Question 2

Who has the highest incidence of heart failure at a younger age

Answer 2

Black men and women

Question 3

What is the number one risk factor of Heart failure

Answer 3

Poor management of hypertension

Question 4

Systolic dysfunction

Answer 4

Can’t pump enough

Question 5

Diastolic dysfunction

Answer 5

Can’t fill enough

Question 6

HF reduced EF is characterized by

Answer 6

LV dilation with EF < 40%

Question 7

HF preserved EF

Answer 7

concentric LV hypertrophy with EF > 50%

Question 8

What changes in Systolic dysfunction? EF ?

Answer 8

Ejection Fraction is reduced due to loss of contractility

Question 9

What changes in diastolic dysfunction? EF?

Answer 9

reduced compliance

This has a preserved EF

Question 10

What causes HF Red EF

Answer 10

Infarction

Dialated Cadiomyopathy

Volume overload

Question 11

What causes HF Preserved EF

Answer 11

Hypertension

Restrictive Cardiomyopathy (Sarcoidosis/Amyloidosis/HOCM)

Question 12

What is the sign that is indicitave of very poor outcome of heart failure

Answer 12

Audible S3 w/ backwards heart failure

Question 13

What are the cardinal signs of heart failure

Answer 13

Worsening dyspnea

Paroxysmal nocturnal dyspnea

weight gain

dec exercise capacity

Sleep disordered breathing

Question 14

Audible S3 indicates

Answer 14

Backward failure /Systolic dysfunction

Question 15

Audible S4 indicates

Answer 15

Diastolic dysfunciton

Question 16

Gold standard for heart failure workup

Answer 16

Echocardiogram to get EF

Question 17

What is a biomarker for heart failure

Answer 17

BNP

copeptin

cystatin C

Question 18

What does Ang II activate

Answer 18

AVP and SNS

Question 19

What way does the AVP line graph shift in heart failure

Answer 19

To the left mimicing a loss of blood volume even though there isn’t a loss

Question 20

What do you measure to check on AVP level

Answer 20

Copeptin bc it has a longer halflife

Question 21

How can you help ANP and BNP support heart failure more

Answer 21

Give ernesto to block neprilysin and AT1R

Question 22

What does long activation of ATII cause

Answer 22

oxidative stress

Question 23

What do dying hearts have more of inside them

Answer 23

Calcium. lesser ATP reduces SERCA. The heart cannot relax

Question 24

Failing hearts on EKG

Answer 24

reduced slope phase 0

ERP is shorter (reentry arrythmias)

Question 25

HF red EF present with what type of hypertrophy

Answer 25

eccentric (volume) hypertrophy (series)

Question 26

HF pres EF present with what type of hypertrophy

Answer 26

concentric (pressure) hypertrophy (parallel)

Question 27

Why are ACE inhibitors venodilators and vasodilators

Answer 27

bradykinin is a venodilator

Question 28

Why are ARBs vasodilators

Answer 28

ARBs only prevent ATII which is a vasoconstictor

Question 29

What is BNP

Answer 29

vaso/veno dilator

Question 30

What can provide symptomatic relief in HF

Answer 30

diuretics

Question 31

What diuretic helps in a kidney with a lower filtration rate

Answer 31

Loops

Question 32

What should you use in HF with EF < 35%

Answer 32

Spironolactione Eplerenone

Question 33

What to give when dealing with cardiac remodeling

Answer 33

B blocker (carvedilol) ACE inhibitor Spironolactinone

Question 34

How to give B blockers?

Answer 34

Small amount then work up MONITOR WEIGHT

Question 35

What should you never increase digoxin above

Answer 35

1ng/mL

Question 36

Digoxin side effects

Answer 36

PVCs bradycardia-> tachycardia Yellow vision

Question 37

Treat digoxin

Answer 37

Digibind- Fab fragments

Question 38

What should you always start with in heart failure

Answer 38

ACE inhibitors regardless of Race

Question 39

What do you give if someone doesn't respond to an ACE inhibitor

Answer 39

hydralazine and isosorbide dinitrate (Bidil)

Question 40

What does Ivabradine block

Answer 40

HCN channel to reduce HR

Question 41

Which increases the chance of survival most in sudden cardiac death

Answer 41

Implantable defibrillator

Question 42

Best treatment for preserved ejection fraction HF?

Answer 42

Prevention (only treatment is transplant)