Week 238 - Heart failure Flashcards Preview

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Flashcards in Week 238 - Heart failure Deck (54):
1

Week 238


In the medical management of acute left ventricular failure:

Name a drug with venodilator and diuretic properties often used intravenously.

Furosemide

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Week 238

 

In the medical management of acute left ventricular failure

Name an intravenous venodilator used to lower pre
-load
, also used sublingually in angina management..

Glycerol Trinitrate

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Week 238

 

In the medical management of acute left ventricular failure:

Name an intravenous agent used to reduce the anxiety and distress of dyspnoea.
 

Diamorphine

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Week 238

 

Name a drug acting at the loop of Henle to inhibit sodium reabsorption

Furosemide

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Week 238

 

Name a thiazide related diuretic unsuitable for acute left ventricular failure and reserved exclusively for
refractory chronic heart failure

 

Metolazone

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Week 238

 

Name a loop diuretic 1 mg of which is equivalent to 40 mg of furosemide

Bumetanide

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Week 238

 

Name a beta blocker only licensed for use in chronic heart failure

Carvedilol

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Week 238

 

Name a drug that Inhibits the I/f channel in the sinus node
 

Ivabradine

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Week 238

 

RE: Heart failure. Name a drug that  is Potassium sparing and can cause gynaecomastia
 

Spironolactone

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Week 238

 

If your heart failure patient is already on a beta blocker, and still has a heart rate of more than 70bpm, which drug could you give them next?

Ivabradine

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Week 238

 

In the investigation of chronic heart failure:

Which result has a low value that has a high negative predictive value making heart failure unlikely in an untreated patient (also can be used as a prognostic marker)

Brain natriuretic peptide

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Week 238

 


Which investigation "Gives a functional assessment of coronary perfusion also giving information on
myocardial scarring, ejection fraction and prognosis in coronary artery disease"?
 

Perfusion scintigraphy

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Week 238

 

Which investigation
has a value which can distinguish between
systolic and diastolic
heart failure?
 

Ejection fraction

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Week 238

 

Which investigation (for Heart failure) is useful in identifying hibernating myocardium?

Perfusion Scintigraphy

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Week 238

 

Kerley B lines appear on what type of investigation - and as a result of which lung pathology?

Chest x ray

Result of pulmonary oedema

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Week 238

 

What is the most likely cause of
Heart failure occurring during pregnancy or within
6 months of delivery?
 

Peripartum Cardiomyopathy

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Week 238

 

What is the cause of
Heart failure occurring as a consequence of long standing poorly controlled atrial fibrillation?
 

Tachycardia induced cardiomyopathy

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Week 238

 

What is the name given to a form of heart failure seen as consequence of chronic alcohol abuse?

Dilated cardiomyopathy

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Week 238

 

What is the name given to a form of
heart failure associated with hypertension, diabetes mellitus and left ventricular hypertrophy?
 


Heart failure with preserved
ejection fraction
 

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Week 238

 

What is the name given to a form of heart failure associated with chronic obstructive airways disease and interstitial lung disease?
 

Cor Pulmonale

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Week 238

 

Define: Heart failure


A failure of cardiovascular function to maintain cardiac output to meet the body’s metabolic demands despite normal venous pressures

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Week 238

 

What are the classical symptoms of Left Heart Failure related to?

  • Pulmonary venous congestion
  • Dyspnoea (Shortness of breath)
  • Orthopnoea (SOB when lying flat)
  • Paroxysmal Nocturnal Dyspnoea

 

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Week 238

 

What are the classical symptoms of Right sided heart failure related to?

 

Systemic venous congestion.

  • Peripheral oedema
  • Elevated JVP
  • Hepatomegaly
  • Ascites

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Week 238

 

Name some causes of Right Heart Failure.


Chronic lung disease eg COPD, Fibrotic lung disease
(Cor pulmonale)

Pulmonary hypertension, eg PE

Left to right intracardiac
shunts, eg ASD, VSD (plus Eisenmenger syndrome)

Chronic valvular heart disease or LV dysfunction
 

25

Week 238

 

Which term is used to describe a combination of both L and R heart failure?

Congestive heart failure.

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Week 238

 

What is Cardiac Cachexia?

Weight loss and anorexia commonly seen in HF.

 

Causes metabolic changes, gut congestion, reduced intake, inflammatory causes.

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Week 238

 

What is Systolic Heart Failure?


Symptoms and signs of
heart failure with LV
systolic dysfunction.
 

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Week 238

 

What is Diastolic heart failure?


Symptoms and signs of
heart failure with
preserved LV systolic
function
 

50% of HF patients

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Week 238

 


B type natriuretic peptide (BNP) and N terminal proBNP (NT-proBNP) rise in response to what?

Myocaridal wall stress - aka Heart failure.

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Week 238

 

If a heart failure patient has electrical dysynchrony - what treatment can you use to correct it?

CRT-P

 

synchronises inter and intraventricular contraction.

31

Week 238

 

How do you manage acute Left Ventricular failure?


Oxygen

Diamorphine 2.5 mg, iv (or morphine)

Metoclopramide 10 mg, iv

Furosemide 40
-
80 mg, iv

iv nitrates (glyceryl trinitrate/ISDN)

For refractory cases consider non
-
invasive or
mechanical ventilation.
 

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Week 238


In pulmonary oedema rapid relief will be
obtained by the use of iv _____ (venodilator
and fluid removal).
 

Ferusomide

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Week 238

 


Thiazides and related compounds (metolazone) act at the beginning of the______convoluted tubule to inhibit _____reabsorption.
 

Distal

Sodium

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Week 238

 


Bendroflumethiazide

Chlortalidone

Indapamide

Cyclopenthiazide

Hydrochlorothiazide

Metolazone
 

These are all what type of drug?

Thiazide and related diuretics


Side effects

  • Electrolyte disturbances
  • (Na+ and K+)
  • Gout (urate)
  • Hyperglycaemia
  • Derranged lipids

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Week 238

 

Furosemide and Bumetanide are what type of drug? What are they often used in conjuction with, and why?
 

These are loop diuretics.

 


Often used in combination with K+- sparing diuretics to prevent hypokalaemia, e.g. amiloride or spironalactone e.g. Co-amilofruse or Frumil, 5/40.
 

36

Week 238

 

Amiloride and spironolactone are what type of drug?

These are potassium sparing diuretics.

37

Week 238

 

Opiates don't just stop pain. They are also venodilators. What effect does this have?
 

This reduces pre-load and sympathetic drive.

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Week 238

 

Cyclisine is an anti-emetic. Why is it not given to patients with heart failure? What can you give instead?

Cyclisine causes vasoconstriction.

Use metoclopramide instead.

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Week 238

 

What type of drug is Nitroglycerine? What does it do?

It is a Vasodilator.

 

Reduces preload, afterload and increases stroke volume

No evidence they relieve dyspnoea or any other clinical outcomes.
 

40

Week 238

 

What is Nesiritide? What effect does it have?

It's a vasodilator

 

Human BNP. A vasodilator shown to
reduce dyspnoea in addition to conventional effects.
.
 

41

Week 238

 
Dobutamine, levosimendan, or the PDIII inhibitor - milrinone, are what type of drugs? When are they used?
 

They are + inotropes

They are used (sometimes - on ITU) in cardiogenic shock

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Week 238

 

What is refractory heart failure?

Refractory CHF is defined as symptoms of CHF at rest or repeated exacerbations of CHF despite “optimal” triple-drug therapy. Most patients with refractory CHF require hemodynamic monitoring and treatment in the intensive care unit.

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Week 238

 

ACE-Inhibitors are indicated for all patients in HF with an LVEF less than ____%
 

40%

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Week 238

 

Name some uses/benefits of ACE-I's


Wide body of evidence for use in heart failure. First
line treatment young hypertensive.Reduction in
proteinuria/preservation renal function in diabetic
nephropathy. Prognostic benefits in patients with
IHD and preserved LV function.
 

45

Week 238

 

The prognostic value of which two Ace Inhibitors is shown in  IHD independent of effects on LV function

46

Week 238

 

Name some contraindications to the use of Ace Inhibitors.


Severe AS/MS/LVOT obstruction,e.g. HCM

Bilateral renal artery stenosis

Pregnancy

History of idiopathic/hereditary angioedema

Creatinine > 220mol/l
 

47

Week 238

 

Drugs ending in "Sartan" are which class?

These are Angiotensin 2 receptor antagonists.

 

i.e. Candesartan, and valsartan

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Week 238

 

If you have a patient that can't tolerate ACE-Inhibitors, or Angiotensin Receptor Blockers, What could you use instead, if LVEF <40%?


Use Isosobide dinitrate and hydralazine if
ACEI/ARB not tolerated or in addition to
ACEI/ARB/C=B-Blocker/digoxin/aldosterone
antagonist if still symptomatic and LVEF < 40%.
 

49

Week 238

 

When are Aldosterone Antagonists (i.e. spironolactone and Eplerenone) indicated?


Aldosterone antagonists indicated for severe
symptomatic HF (grade III/IV) with LVEF< 35%).
 

50

Week 238

 

What are the main contraindications for the use of Beta blockers?



Asthma/COPD

Cardiac conduction defects

Severe heart failure

Severe peripheral vascular
disease

Raynaud’s
disease

Unopposed in phaeochromocytoma (must use with alphablocker)
 

51

Week 238

 

Labetalol is a beta blocker. In which circumstances is it best used/most useful?

Labetolol: an alpha and Beta adrenoceptor blocker
Useful in pregnancy and as an iv infusion in
the rapid control of BP e.g. in aortic dissection

 

52

Week 238

 

What does Ivabradine do?


Inhibits the I/f channel in the sinus node, slowing the heart rate in sinus rhythm (but not in AF).
 

53

Week 238

 

Which drugs can cause or contribute to heart failure?

  • NSAIDS and co-2 inhibitors
  • Anthracylines
  • Verapamil and diltiazem
  • glitazones
  • clozapine
  • TNF alpha inhibitors i.e. infliximab
  • itraconazole
  • liquorice
  • TCA's

54

Week 238

 

What effect does Digoxin have?

  • Increases cardiac contractility
  • Slows heart rate