Treatment of Heart Failure-Al-Mehdi

Question 1

what must be present for diagnosis of HF

Answer 1

increase in LA pressure (increase in PCWP)

Question 2

HF mortality rate=

Answer 2

50% w/in 5 years of diagnosis

Question 3

ischemia-MI
HTN, stenosis
Arrythmias

Answer 3

cause HFrEF

Question 4

LV hypertrophy
HTN
myocardial fibrosis

Answer 4

cause HFpEF

Question 5

binds ______ in hypothalamus that then makes POMC (and alpha-MSH)

Answer 5

leptin; arcuate nucleus

Question 6

alpha-MSH binds ____ receptor on PVN neurons that inhibit______ causing RVLM stimulation and sympathetic activation

Answer 6

MC4 receptors; NTS receptors

Question 7

what leads to LV workload increasing and maladaptive remodeling and hypertrophy of LV

Answer 7

renin increasing Ang II leading to vasoconstriction and increase in afterload

Question 8

myocyte hypertrophy/necrosis and perivascular and interstitial fibrosis

Answer 8

concentric remodeling

Question 9

this leads to ventricular enlargement and systolic/diastolic dysfunction and changes in wall stress

Answer 9

concentric remodeling

Question 10

1st hit after concentric remodeling where you can still preserve EF

Answer 10

concentric LVH

Question 11

2nd hit to the heart from MI/myocarditis can lead to what

Answer 11

eccentric LVH dilatation

Question 12

force holding aortic valve closed

Answer 12

diastolic pressure

Question 13

what is the same in HFpEF and HFrEF

Answer 13

LVEDP

Question 14

pathognomonic sign of HF

Answer 14

orthopnea

Question 15

most common sign of HF

Answer 15

Dyspnea

Question 16

what causes dyspnea in HF

Answer 16

interstitial pulmonary edema

Question 17

another sign of HF in lower extremities

Answer 17

pitting edema

Question 18

what causes increase in PCWP in HF

Answer 18

congestion (pulmonary edema)

Question 19

muscle mass loss

Answer 19

cachexia

Question 20

what causes cachexia and can lead to anorexia

Answer 20

TNFalpha increase in CHF

Question 21

what cytokines also increase in CHF

Answer 21

IL-6 and CRP

Question 22

lab that is highly pathognomonic of cardiovascular disease

Answer 22

NT-proBNP

Question 23

biomarker in CVD for myocyte necrosis

Answer 23

Troponin Ic

Question 24

biomarker in CVD for inflammation

Answer 24

CRP, IL-6

Question 25

biomarker in CVD for accelerated atherosclerosis

Answer 25

LDL HbA1c BG

Question 26

biomarker in CVD for vascular damage

Answer 26

CrCl, Cystatin C, microalbuminuria

Question 27

biomarker in CVD for hemodynamic stress

Answer 27

NT-proBNP

Question 28

normal EF

Answer 28

around 67% (2/3rds of contents ejected out)

Question 29

first line Rx for HFrEF

Answer 29

ARBs/ACEIs beta blockers ARNI Aldosterone antagonists

Question 30

specific beta blockers used to treat HFrEF (nbmc)

Answer 30

carvedilol bisoprolol nebivolol metoprolol

Question 31

ARNI made up of what 2 drugs

Answer 31

Valsartan + Sacubitril

Question 32

Ang II receptor that is involved with maladaptive remodeling

Answer 32

AT1R (Gq)

Question 33

what two drugs decrease mortality in patients with HFrEF

Answer 33

ACEIs/ARBs and beta blockers

Question 33

mechanistic reasoning why you use beta blockers in HFrEF

Answer 33

reduce preload and increase beta receptor density

Question 34

what drugs should not be used in HFrEF

Answer 34

cardiac CCB's

Question 35

SGLT2i

Answer 35

-GLIFLOZIN

Question 36

sGC agonists (like NO)

Answer 36

-CIGUAT

Question 37

second line for HFrEF

Answer 37

SGLT2i sGC agonists Ivabradine omecamtiv mecarbil

Question 38

myosin activator used to treat HFrEF

Answer 38

Omecamtiv mecarbil

Question 39

act at PCT S1 location and inhibit Na+-glucose cotranporter

Answer 39

SGLT2i (-GLIFLOZINs)

Question 40

3rd line treatment of HFrEF and its SE's

Answer 40

Digoxin; yellow eyes and anorexia

Question 41

used to treat AFIB/arrhythmia in HFrEF

Answer 41

AMIODARONE

Question 42

HFrEF stage with structural heart disease and treated w/ ARBs/ACEIs

Answer 42

stage B or II

Question 43

stage of HFrEF when symptoms start

Answer 43

stage C or III

Question 44

rate limiting step of inotropy by myosin activation/inactivation

Answer 44

ADP-Pi dissociation

Question 45

prevents premature ADP-Pi dissociation and activates myosin directly

Answer 45

Omecamtiv Mecarbil

Question 46

myosin inactivator

Answer 46

MAVACAMTEN

Question 47

max reduction in mortality w/ HFrEF

Answer 47

OMECAMTIV MECARBIL

Question 48

microvascular endothelial inflammation by comorbidities (decrease in NO)

Answer 48

pathogenesis of HFpEF

Question 49

Rx of HFpEF

Answer 49

ACEIs/ARBs ARNI SGLT2i antifibrotic agents

Question 50

vasodilator peptide drugs used to treat HFpEF

Answer 50

ANP, CNP, urodilantin

Question 51

_____ elevation is pathognomonic for HFpEF

Answer 51

NT-proBNP

Question 52

ANP and BNP cause what when PKG is activated

Answer 52

natriuresis

Question 53

human ANP (hANP)

Answer 53

CARPERITIDE

Question 54

human BNP (hBNP)

Answer 54

NESERITIDE

Question 55

sign of CHF when you have sob while laying down and it is relieved by standing up

Answer 55

orthopnea

Question 56

causes of acute heart failure

Answer 56

MI/ischemia iatrogenic volume overload

Question 57

symptoms of______ in acute HF include: dyspnea, lower extremity swelling, abdominal discomfort

Answer 57

congestion

Question 58

symptoms of _____ in acute HF include: fatigue, dizziness, and confusion

Answer 58

low perfusion

Question 59

to treat AHF w/ hypoperfusion

Answer 59

dobutamine, dopamine, milrinone

Question 60

to treat AHF w/out volume overload

Answer 60

NTG sodium nitroprusside nesiritide

Question 61

to treat AHF w/ normotensive and w/ volume overload

Answer 61

loop diuretics

Question 62

to treat AHF w/ pulmonary edema

Answer 62

vasodilators diuretics

Question 62

first line treatment for AHF

Answer 62

NO donor vasodilators (NTG, sodium nitroprusside) loop diuretics (furosemide, torsemide)