Cardiology: Hf Therapy

Front 1

Two axes in the neurohormonal system that are most deleterious in HF?

Back 1

Sympathetic
RAAS

Front 2

1) Blood test which can quantify HF?
2) Does this correlate with symptoms?
3) Mortality?

Back 2

1) BNP
2) yes
3) Yes

Front 3

lifestyle modifications that are recommended in HF

Back 3

stop smoking
normal weight
restrict Na+ intake to 2g a day
weigh daily
aerobic activity

Front 4

1) Which receptor does AII bind to?
2) binding in different tissues can cause many things.... name five.

Back 4

1)AT1
2) Vasoconstriction
ADH
thirst
SNS activation
Salt and water retention

Front 5

1) do ACE inhibitors improve HF mortality?

2) does it matter much which drug from the class is used?

Back 5

1) yes

2) no, class effect

Front 6

1) What is the rationale for using A2RBs over ACE-Is?

2)do they have mortality benefits?

3) Do they have better mortality than ACE-Is?

4) Indication fo A2RBs?

Back 6

1) there are other pathways for AI--> AII activation.

2) yes

3) No, they do not show significant decrease in mortality compared to ACE inhibitors
4) Resistance to ACE-I

Front 7

1) Two reasons for high aldo in HF
2) Can cause hypo___ and hypo ___

3) At the myocardial tissue level, aldosterone can cause four bad sequelae

4) Name two important aldosterone blockers used in HF

5) Do they reduce mortality?

Back 7

1) high production stimulated by AII, decreased clearnace

2)hypomagnesemia, hypokalemia

3) interstitial fibrosis, endothelial dysfunction, myocyte hypertrophy, vascular remodeling

4) Spironolactone, Eplenerone
5) YEs, both decrease mortality

Front 8

Aldosterone blockers lower mortality principally by lowering what immediate cause of death?

Back 8

sudden cardiac death

Front 9

1) SNS has its pathogenesis by stimulating what two receptor types?

Back 9

1) Alpha and beta

Front 10

1) Chronic stimulaton of beta receptors in the heart results in what phenotype?

2) What happens to beta receptor levels?

3) Do Beta blockers improve mortality?

4) Is this a class effect or does the drug choice matter alot?

5) Name the two new generation beta blockers and why they are special.

Back 10

1) Hypertrophic, inotropic, chronotropic
2) decrease
3) Yes, beta blockers decrease mortality
4) Not a class effect
5) mixed apha and beta1 blcokers (Carvedilol, bucindolol)

Front 11

1) How does Digoxin work?

2-3) Particularly useful in ___2__ LV with poor __3___ function

4) dangers of Dig?

5) Is there a mortality benefit of Digoxin?

6) Dig dose is based upon what two parameters?

Back 11

1) Inhibits Na/K ATPase resulting in higher intracellular Ca++ leading to greater contractility.

2) dilated
3) systolic
4) narrow therapeutic window, synergistic toxicity with K+ abnormalities, many interactions
5) No
6) lean body mass and renal function

Front 12

1) Two signs of digoxin toxicity

2) how do we treat mild digoxin toxicity?

3)severe?

Back 12

1) halos around lights, paroxysmal atrial tachycardia

2) cessation and lidocaine or dilantin

3) Digibind (mAb)

Front 13

DIuretics:
1) Have loop diuretics been shown to decrease mortality in HF?
2) How about aldo antoagonists?

Back 13

1) no
2) yes

Front 14

Hydralazine and Nitrates:
1) Function?
2) Do they decrease mortality over placebo
3) How do they compare to ACE inhibitors in terms of mortality benefit?
4) Main indication?

Back 14

1) vasodiltors
2) yes
3) inferior to ACE inhibitors
4) combination therapy for people with HF and real insuficiency

Front 15

Non Digitalis inotropic agents:
1) They ca act in two ways, describe.

2) How do they change mortality?

3) when are they used?

Back 15

1) direct Beta stimulation, PDE blockade. Both lead to increased intracellular Ca++

2) THEY INCREASE MORTALITY!!!!!

3) bridge to other therpy

Front 16

Recombinant BNP has been shown to decrease ____1____ and improve symptoms in patients with decompensated HF.

2) Do we have mortality data?

Back 16

1) Ventricular filling pressure
2) not yet

Front 17

1) Patients with EF= 30-35% despite medical therapy are eligible for what intervention?

2) Patients with LBBB and QRS duration >130ms are eligible for what intervention?

3) ____3____ may be used as a bridge to transplant or as a destination therapy for patients with LV dysfunction.

Back 17

1) ICD
2) dual chamber pacer
3) LVAD

Front 18

HEart can maintain a reasonable CO, but only with elevated filing pressures

Back 18

backward failure

Front 19

What % of patients above 65 have HF?

Back 19

10%

Front 20

Most common cause of HF

Back 20

Ischemia

Front 21

Name 5 neurohormones which when elevated, predict death from HF

Back 21

AII, ANP, Aldo, NE, Epi

Front 22

5 broad goals of HF Tx

Back 22

Control symptoms
Prevent disease progression
Decrease hospitalization
Decrease mortality
Prevent ventricular remodeling, vascular remodeling, and activation of neurohormones

Front 23

What drug clss is given only to NYHA IV patients?

Back 23

Inotropes

Front 24

1) Whic bt receptor usually predominated in the heart?
2) Which one causes most detrimental effects of SNS on heart in HF?
3) Which is upregulated in HF?
4) Which is downregulated?

Back 24

1) B1
2) B1
3) alpha
4) B1

Front 25

5 responses of the heart to drenergic stimulus

Back 25

myocyte growth
inotropy
chronotropy
myocyte toxicity
apoposis

Front 26

4 benefits of beta blockade in HF

Back 26

Decreased Mortality (30-35% reduction)
Increase in LVEF (reverse remodelling)
Improvement in NYHA Functional Status
Decrease in All Cause and HF Hospitalizations

Front 27

Do ICDs cause a mortality reduction in sudden cardiac death?

Back 27

yes

Front 28

what is the single largt cause of death in the US?

Back 28

Sudden cardiac death.

Front 29

does cardiac resynchronization (V pacer) therapy cause a reduction in mortality?

Back 29

yes

Front 30

1) THE major indication for heart transplant.

2) other major criteria

Back 30

1) All other appropriate medical and surgical options have been exhausted

2) Patients with an unacceptably limited prognosis and/or
Patients with an unacceptable quality of life secondary to congestive heart failure symptoms

Front 31

What should be the inital therapy for HF, whe it presents asymptomatically

Back 31

ACE-I and Beta blockers

Front 32

what population benefits most from hydralazine?

Back 32

African americans

Front 33

Aldosterone blockade in indicated in severe or mild HF?

Back 33

severe