Block 3: Clinical Aspects Of Chf 2

Front 1

If ACEI and beta blockers are good for treating inappreopriate neurohumoral activation; and Angiotensin receptor blockers and beta blockers are good when ACEIs are intolerated; is ACEI + ARB + beta blocker the best?

Back 1

NO!
these patients do worse
use only 2

Front 2

NYHA Class 1 for heart failure?
NYHA Class 2?
Class 3?
class 4?

Back 2

class 1- no sx
class 2- sx w/ ordinary activity
class 3- sx w/ less than ordinary activity
class 4- sx at rest

Front 3

what improves exercise capacity in patients with systolic failure without increasing mortality

Back 3

digoxin

Front 4

early in a patient's course of heart failure addition of ___ may be adquate to relieve fluid retention by increasing forward flow

Back 4

ACEI

Front 5

addition of ___ has been shown to further reduce the need for admission to the ER for acute diuresis

Back 5

digoxin

Front 6

as heart failure progresses and cardiac output falls,___ become necessary for symptomatic relief

Back 6

diuretics- loop are good but may cause hypokalemia; potassium sparing are good but may cause hyperkalemia w/ ACEI present

Front 7

en end-stage heart failure- where the patient is typically experiencing intolerable sx at rest), the use of low-dose ___ (to improve forawrd flow and renal perfusion) and ___ (a venodilator) become essential

Back 7

dopamine
morphine

Front 8

who usually dies of sudden arrhythmic death, class 2 or class 4 patients

Back 8

class 2 patients
class 4 patients end up suffering lingering ends

Front 9

what class of drug is most important at reducing the risk of sudden death

Back 9

beta blockers

Front 10

name five conditions that put patients at high risk for the development of heart failuare and should be treated aggressively

Back 10

uncontrolled hypertension
untreated lipid disorders
tachycardia
valvular disease
thyroid disease

Front 11

what is the first rule in treating heart failure

Back 11

make sure left ventricular dysfunction is present- use an objective measure (ECG) to rule out anything that can mimic heart failure

Front 12

what does "classify the type of LV dysfunction" mean and how do you do it?

Back 12

determine if its systolic or diastolic dysfunction
ECG, nucleotide study, angiogram! (better do it)

Front 13

What is the leading cause of diastolic dysfunction

Back 13

hypertension!
treate aggressively

Front 14

what is essential for all patients with systolic dysfunction

Back 14

afterload reduction with aFCEI
BP should be normal
reduce ETOH intake
inc K intake
avoid NSAIDS

Front 15

systolic dysfunction
class 1: drug?
class 2: ?
class 3: ?
class 4?

Back 15

class 1- ACEI
class 2- beta blocker
class 3- beta blocker and digoxin and spironolactone
class 4- beta blocker, digoxin, transplant?

Front 16

what is the most common iatrogenic error in heart failure management

Back 16

inducing symptomatic bradycardia with excessive beta blockade
- patient may describe new dyspnea upon exertion

Front 17

iatrogenic hypokalemia is from...

Back 17

excessive diuresis

Front 18

iatrogenic hyperkalemia is from...

Back 18

K-sparing diuretic and ACE-I

Front 19

iatrogenic induction of acute renal failure is from...

Back 19

combining NSAID with ACEI

Front 20

to avoid digoxin toxicity...what is the goal serum level

Back 20

between 0.5-0.8 ng/mL