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57 Cards in this Set
- Front
- Back
What causes systolic heart failure?
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Any disease process that damages or destroys ventricular muscle.
(myocardial infarction) *This results in reduced contractility |
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What is the fundamental problem that results in diastolic heart failure?
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The heart loses compliance (becomes more fibrous), thus grows stiffer.
*The heart cannot relax adequately, limiting filling. |
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What is the effect of early diastolic heart failure on contractile function,cardiac output, ejection fraction, and stroke volume?
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EARLY ON:
Contractile function = normal Ejection fraction = normal Cardiac output = normal Stroke volume = LOW *The ejection fraction is normal because both the stroke volume and EDV are reduced *Cardiac output iis normal because an increase in heart rate compensates for the lower stroke volume *OVER TIME, contractile function diminishes |
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Is pulmonary congestion a result of systolic or diastolic heart failure?
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Diastolic heart failure
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What is the change in contractility mediated by?
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Changes in intracellular concentration of free calcium
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Where does fluid accumulation occur with right sided heart failure?
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Liver and peripheral edema
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Where does fluid accumulation occur with left sided heart failure?
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Lungs
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In the U.S., what is the primary cause of heart failure?
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Ischemic disease (or MI)
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In the world, what is the primary cause of heart failure?
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Hypertension
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What is the New York Heart Association (NYHA) classification of heart failure based on?
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Exercise capacity
(functional scheme) |
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What do the American College of Cardiology (ACC) and American Heart Association (AHA) base their classification of heart failure on?
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Staging or progression of heart failure
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Describe the 4 classes of the NYHA classification of heart failure
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Class I: Asymptomatic cardiac disease
Class II: Dyspnea with heavy exertion Class III: Dyspnea with light exertion Class IV: Dyspnea at rest |
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Describe the 4 stages of the ACC and AHA classification of heart failure.
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Stage A: Risk factors for heart failure present
Stage B: Asymptomatic for heart failure Stage C: Symptomatic for heart failure Stage D: Refractory to treatment or at the end stage of heart failure |
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Based on the ACC and AHA classifications, which stage would a patient be at if he/she was experiencing SOB, fatigue, and reduced exercise tolerance?
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Stage C
(symptomatic for heart failure) |
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Based on the ACC and AHA classification for heart failure, which stage would the patient be at if he/she had a previous MI and asymptomatic valvular disease?
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Stage B
(asymptomatic for heart failure) |
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Based on the ACC and AHA classification for heart failure, which stage would the patient be at if he/she was experiencing severe symptoms at rest despite maximal medical therapy?
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Stage D
(Refractory to treatment) |
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Based on the ACC and AHA classification for heart failure, which stage would the patient be at if he/she has hypertention, diabetes mellitus, or coronary artery disease?
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Stage A
(risk factors for heart failure) |
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How does heart failure lead to a reduction in arterial pressure?
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Reduced cardiac output
(MAP = CO x TPR) |
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How does heart failure stimulate the renin-angiotensin-aldosterone system?
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Decreased CO --> Decreased arterial pressure --> Decreased renal perfusion --> Increased renin release
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How does heart failure result in an increase in sympathetic nervous system activity, and what are the 3 main effects of this?
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Decreased CO--> Decrease MAP--> activation of baroreceptor reflex --> increases sympathetic NS.
Effects: 1. Vasoconstriction --> increases TPR to directly restore MAP 2. Increased renin secretion --> increases BV 3. Remodeling of the heart |
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What are the 2 deleterious effects of vasoconstriction during heart failure?
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Due to increased TPR and afterload the following occurs:
1. Reduced CO 2. Increased cardiac filling pressure because SV decreases |
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What are the 3 effects of angiotensin II during heart failure?
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1. Vasoconstriction
2. Remodeling of the heart 3. Increased release of aldosterone--> increased Na+ and water retention --> increased cardiac filling pressure |
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When are drugs that affect contractility used during heart failure?
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At the end-stages of heart failure
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List the treatment algorithm for the management of heart failure.
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1. Loop diuretic
2. ACE inhibitor 3. B-blocker (one main limitation) 4. Aldosterone inhibitor 5. Angiotensin receptor inhibitor 6. Inotropic agent |
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Which diuretics are the only ones that can adequately reduce plasma volume?
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Loop diuretics
(block Na+ resportion in the thick ascending limb) |
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How do loop diuretics reduce the work of the heart?
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By reducing plasma volume, they reduce EDV and pressure, which reduces the work of the heart.
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Why is furosemide a particularly effective loop diuretic?
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It also increases venous capacitance, which reduces preload
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When are thiazide diuretics used in heart failure?
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When the patient doesn't respond to loop diuretics
(however, thiazide diuretics are not as effective) |
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What is the major influence of K+-sparing/aldosterone antagonists on heart failure?
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Reduction in remodeling of the heart
(aldosterone somehow enhances cardiac remodeling) |
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Which K+-sparing/aldosterone antagonists are used for heart failure?
What is a big advantage of these drugs? |
1. Spironolactone
2. Eplerenone *These drugs have been shows to reduce mortality in heart failure (Amiloride and triamterone are not used) |
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List 4 actions of angiotensin II that are inhibited by ACE inhibitors.
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ACE inhibitors block the following events:
1. Vasoconstriction --> leads to decreased afterload. Reduced venoconstriction leads to lower filling pressures and EDVs. 2. Secretion of aldosterone --> less Na+/water retension 3. Cardiac remodeling --> reverses remodeling 4. Sympathetic outflow --> reduced |
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For which people can ACH inhibitors be the first drug of choice for treating heart failure?
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1. People who have no overt signs of heart failure and do not need diuretics
2. People who cannot tolerate diuretics |
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List 2 ACE inhibitors.
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1. Captopril
2. Enalopril |
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What is the MOA of metroprolol succinate?
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Selective B1-adrenergic antagonist
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What is the MOA of Bisoprolol?
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Selective B1-adrenergic antagonist
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What is the MOA of Carvedilol?
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1. Non-selective B-adrenergic antagonist
2. Selective a1-adrenergic antagonist |
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What severity of heart failure are beta-blockers recommended to treat?
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Mild - moderate heart failure
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How should beta blocker be administered?
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Very low doses, with the dose gradually increased over a period of two to four months
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List 2 adverse effects of beta blockers.
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1. Exacerbate heart failure
2. Bronchoconstriction |
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Which other group of medications is recommended if a patient cannot tolerate ACE inhibitors?
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Angiotensin receptor antagonists
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Which 2 AT receptor blockers have been tested for use in heart failure?
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1. Candesartan
2. Valsartan |
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What is the only cardiac glycoside used to treat heart failure?
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Digoxin
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What is the MOA of Digoxin?
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Blocks the Na+-K+-ATPase.
(This increases the intracellular concentration of Na+, which increases the intracellular concentration of Ca2+) *More Ca2+ is stored in the SR, so when the cell becomes depolarized, more Ca2+ will be released --> increased contractility *The NCX transporter cannot extrude Ca2+ from cell when there is a low extracellular concentration of Na+ |
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If digoxin improves ventricular function, why is it so low on the the recommended therapeutic sequence?
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Because it does not reduce mortality, and most of the other medications do.
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Digoxin is recommended for which patients?
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1. High heart rate
2. Not adequately treated for heart failure with the other recommended drugs |
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What are the adverse effects of digoxin?
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Cardiac arrhythmias, which can lead to sudden death
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List two B agonists that may be used to treat heart failure.
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1. Dopamine
2. Dobutamine *Stimulate B1 receptors which increases contractility |
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When are B agonists used to treat heart failure?
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When the patient is in the hospital because of severe heart failure.
(Drugs are given IV for short periods of time). |
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Chronic use of which drugs is associated with INCREASED mortality from heart failure?
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B agonists
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What is the major effect of isosorbide dinatrate that makes it an option for treating heart failure?
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Increased venous capacitance--> reduces ventricular filling
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How is Hydralazine beneficial for treating heart failure?
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Reduces afterload by reducing pulmonary and systemic vascular resistance
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Which two drugs are combined to form Bidil?
What is the effect of this combination? |
Isosorbide dinitrate + hydralazine
Combined, they reduce both venous and arterial resistances *Shown to decrease mortality in African American males |
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What is the standard therapy for African Americans for heart failure?
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ACE inhibitors + B-blockers + Bidil (isosorbide dinitrate + hydralazine)
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Which natriuretic peptide may be used in treating dyspnea associated with heart failure?
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Nesiritide
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What is Nesiritide approved to treat?
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Dyspnea caused by heart failure
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Which drug is a recombinant version of brain natriuretic peptide (BNP)?
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Nesiritide
*Produces Na+/water excretion; vasodilation |
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List 4 factors that stimulate cardiac remodeling.
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Increases in the following:
1. Sympathetic NS 2. Aldosterone 3. Angiotensin II 4. Filling pressure |