Heart failure Dr.oches

HEART FAILURE defintion

impairment of ventricular fillings or ejection of blood

HFpEF

In this type of heart failure, the heart's pumping ability is okay, but it has trouble relaxing and filling with blood properly.

HFrEF

In this type of heart failure, the heart's pumping ability is reduced, meaning it doesn't pump blood out as well as it should with each heartbeat.

CAD (Myocardial infarction or ischemia)

limits blood flow to coronary arteries

• heart doesn’t get O2 rich blood (ischemia)

HFpEF symptoms

Pulmonary congestion, Dyspnea (SOP) & reduced exercise

which of these options do both AGII and aldosterone cause?

A. Na+ excretion

B. Na+ retention

C. H2O excretion

Na+ retention

which of these is aNorepinephrine effect/side affects on heart

• Bradycardia

• ventricular hypertrophy and remodeling

• decreased contractility

ventricular hypertrophy and remodeling

what causes BNP (natriuretic peptides) to be released?

A. Volume depletion/decreased pressure

B. volume overload/increased pressure

volume overload/increased pressure

LVEF ≤40% (0.4)

HF with reduced EF (HFrEF)

LVEF 41%-49% (0.41-0.49)

HF with mildly reduced EF (HFmrEF)

LVEF ≥50% (0.5)

HF with preserved EF (HFpEF)

Previous LVEF ≤40% and a follow-up measurement of LVEF >40%

HF with improved EF (HFimpEF)

What law or mechanism describes the direct relationship between myocardial stretching and contractility?

Frank Starling Mechanism

What are the primary symptoms of heart failure?

Dyspnea, Fatigue, Fluid overload

Which of the following medications is known for exacerbating heart failure symptoms?

a) Metoprolol

b) Naproxen

c) Lisinopril

d) Furosemide

Naproxen

Which class of medications can negatively impact heart function and exacerbate heart failure symptoms?

a) ACE Inhibitors

b) Non-DHP CCBs

c) Statins

d) Beta-2 Agonists

Non-DHP CCBs

Which chemotherapy drugs are associated with cardiotoxicity and can lead to heart failure?

a) Methotrexate

b) Doxorubicin

c) Cyclophosphamide

d) Vincristine

Doxorubicin

Which class of substances can increase heart rate and blood pressure, potentially exacerbating heart failure symptoms?

a) Antibiotics

b) Antidepressants

c) Stimulants

d) Antihistamines

Stimulants

Which class of medications is associated with sodium and water retention, potentially exacerbating heart failure symptoms?

a) Calcium Channel Blockers

b) Anticoagulants

c) COX-2 Inhibitors

d) NSAIDs

COX-2 Inhibitors

Which medication, used in the treatment of diabetes, has been associated with an increased risk of heart failure hospitalization, particularly in patients with pre-existing heart failure?

a) Saxagliptin

b) Metformin

c) Insulin glargine

d) Pioglitazone

Saxagliptin

High doses of which medication can lead to fluid retention and exacerbate heart failure symptoms?

A) Prednisone

B) Metoprolol

C) Levothyroxine

Prednisone

Which NYHA Functional Classification category describes patients with cardiac disease but without limitations of physical activity?

a) Class I

b) Class II

c) Class III

d) Class IV

Class I

In which NYHA Functional Classification category do patients experience slight limitations of physical activity, with ordinary activity resulting in fatigue, palpitation, dyspnea, or angina?

a) Class I

b) Class II

c) Class III

d) Class IV

Class II

Which NYHA Functional Classification category indicates marked limitation of physical activity, where less than ordinary activity will lead to symptoms, although patients are comfortable at rest?

a) Class I

b) Class II

c) Class III

d) Class IV

Class III

Patients in which NYHA Functional Classification category experience symptoms of congestive heart failure even at rest, and any physical activity leads to increased discomfort?

a) Class I

b) Class II

c) Class III

d) Class IV

Class IV

Which stage of heart failure classification includes patients who are at risk for heart failure but do not currently have symptoms or signs of heart failure, and do not have structural or functional heart disease?

a) Stage A

b) Stage B

c) Stage C

d) Stage D

Stage A

In which stage of heart failure classification do patients experience marked heart failure symptoms that significantly interfere with daily life and often result in recurrent hospitalizations, despite attempts to optimize guideline-directed medical therapy (GDMT)?

a) Stage A

b) Stage B

c) Stage C

d) Stage D

Stage D

Which stage of heart failure classification includes patients who have current or previous symptoms/signs of heart failure?

a) Stage A

b) Stage B

c) Stage C

d) Stage D

Stage C

In which stage of heart failure classification do patients not have current symptoms or signs of heart failure but show evidence of structural heart disease or increased filling pressures?

a) Stage A

b) Stage B

c) Stage C

d) Stage D

Stage B

What is the preferred treatment approach for diabetes in patients classified as Stage A of heart failure?

a) Insulin therapy

b) Sulfonylureas

c) SGLT2 inhibitors

d) DPP-4 inhibitors

SGLT2 inhibitors

Which of the following medications is recommended for all patients with a left ventricular ejection fraction (LVEF) of 40% or less in Stage B of heart failure?

a) Statins

b) ACE inhibitors

c) Thiazolidinediones (TZDs)

d) Non-DHP calcium channel blockers (CCBs)

ACE inhibitors

In Stage B of heart failure, which medication is recommended for patients with a recent or remote history of myocardial infarction (MI) or acute coronary syndrome (ACS) and a left ventricular ejection fraction (LVEF) less than 40%, if intolerant to ACE inhibitors?

a) Statin therapy

b) Beta blockers

c) ARBs

d) Thiazolidinediones (TZDs)

ARBs

Which combination of medications represents guideline-directed medical therapy (GDMT) for most patients with heart failure with reduced ejection fraction (HFrEF) in Stage C?

a) ACE inhibitor + ARB + MRA

b) ARNI + Beta blocker + MRA + SGLT2 inhibitor

c) Thiazide diuretic + Loop diuretic + Aldosterone antagonist

d) Calcium channel blocker + Digoxin + Ivabradine

ARNI + Beta blocker + MRA + SGLT2 inhibitor

Which class of medications is recommended for all patients with heart failure with reduced ejection fraction (HFrEF) in Stage C, regardless of symptoms?

a) Calcium channel blockers

b) Thiazide diuretics

c) ARNI/ACE-I/ARB

d) Digoxin

ARNI/ACE-I/ARB

Which beta blockers are preferred for use in all patients with HFrEF in Stage C?

a) Atenolol, labetalol, propranolol

b) Bisoprolol, metoprolol succinate, carvedilol

c) Diltiazem, verapamil

d) Nebivolol, pindolol, sotalol

Bisoprolol, metoprolol succinate, carvedilol

Under what conditions are aldosterone receptor antagonists recommended for use in Stage C of heart failure?

a) NYHA Class I with LVEF > 50%

b) NYHA Class III with LVEF > 50%

c) NYHA Class II-IV with LVEF ≤ 35%

d) NYHA Class IV with LVEF > 40%

NYHA Class II-IV with LVEF ≤ 35%

When should SGLT2 inhibitors be considered for use in patients with HFrEF in Stage C?

a) Only in diabetic patients with NYHA Class III symptoms

b) Any patient with HFrEF with NYHA Class II-IV symptoms with adequate renal function

c) Only in patients with a history of myocardial infarction

d) Only if other medications have failed to control symptoms

Any patient with HFrEF with NYHA Class II-IV symptoms with adequate renal function

In Stage D of heart failure with reduced ejection fraction (HFrEF), what is the recommended action for patients who have failed to respond to appropriate measures from Stages A, B, and C?

a) Discontinue all medications

b) Refer for specialty heart failure care to assess for more advanced therapies

c) Increase the dose of current medications

d) Initiate experimental surgery or drugs

Refer for specialty heart failure care to assess for more advanced therapies

Which treatment option is appropriate for patients in Stage D of heart failure with reduced ejection fraction (HFrEF) who are not candidates for heart transplantation and have refractory symptoms?

a) Cardiac transplant

b) Increase the dose of ACE inhibitors

c) Start aggressive diuresis

d) Initiate inotropes

Cardiac transplant

In which scenario would Angiotensin II Receptor Blockers (ARBs) be preferred over ACE inhibitors in patients with heart failure?

a) When a patient requires a medication with a direct positive inotropic effect

b) When a patient experiences cough and angioedema as side effects of ACE inhibitors

c) When a patient has a known allergy to ARBs

d) When a patient has severe renal impairment

When a patient experiences cough and angioedema as side effects of ACE inhibitors

What is the primary mechanism of action of Sacubitril/Valsartan (Entresto) in heart failure?

a) Inhibition of angiotenneprilysineptors

b) Inhibition of neprilysin

c) Stimulation of renin secretion

d) Blockade of beta-adrenergic receptors

b) Inhibition of neprilysin

In which type of heart failure has Sacubitril/Valsartan (Entresto) demonstrated a clear benefit in reducing morbidity and mortality?

a) Heart failure with preserved ejection fraction (HFpEF)

b) Heart failure with reduced ejection fraction (HFrEF)

c) Acute decompensated heart failure

d) Valvular heart disease

b) Heart failure with reduced ejection fraction (HFrEF)

When considering treatment options for heart failure with preserved ejection fraction (HFpEF), what role does Sacubitril/Valsartan (Entresto) play based on available evidence?

a) It is recommended as first-line therapy to improve survival.

b) It has demonstrated significant reduction in hospitalizations and mortality compared to placebo.

c) It may be considered to decrease hospitalizations, particularly in patients with lower range of LVEF.

d) It is contraindicated due to potential adverse effects.

c) It may be considered to decrease hospitalizations, particularly in patients with lower range of LVEF.

What was the primary finding of the PARAGON-HF trial regarding Sacubitril/Valsartan (Entresto) in patients with heart failure with preserved ejection fraction (HFpEF)?

a) It significantly reduced hospitalizations and mortality compared to placebo.

b) It demonstrated no statistical significance in hospitalizations or mortality compared to placebo.

c) It was associated with increased adverse events compared to placebo.

d) It showed superiority over ACE inhibitors in improving survival in HFpEF patients.

b) It demonstrated no statistical significance in hospitalizations or mortality compared to placebo.

In which landmark trial did Sacubitril/Valsartan (Entresto) demonstrate decreased morbidity and mortality compared to enalapril in patients with heart failure with reduced ejection fraction (HFrEF)?

a) PARADIGM-HF

b) PARAGON-HF

c) TOPCAT

d) SHIFT

a) PARADIGM-HF

What precaution should be taken when transitioning a patient from an ACE inhibitor to Sacubitril/Valsartan (Entresto)?

a) Immediate switch without any washout period

b) A 24-hour washout period is sufficient

c) A 36-hour washout period is required to prevent an increased risk of angioedema

d) Switching should be avoided as it may lead to adverse events

c) A 36-hour washout period is required to prevent an increased risk of angioedema

In which patients with heart failure is the use of mineralocorticoid receptor antagonists recommended to reduce hospitalizations and mortality?

a) Only in patients wieplerenoneed ejection fraction (HFpEF)

b) Only in patients with NYHA Class IV symptoms

c) In patients with heart failure with reduced ejection fraction (HFrEF) and NYHA Class II – IV symptoms

d) In all patients with heart failure regardless of symptoms

c) In patients with heart failure with reduced ejection fraction (HFrEF) and NYHA Class II – IV symptoms

What are the two main mineralocorticoid receptor antagonists commonly used in the treatment of heart failure?

a) Spironolactone and lisinopril

b) Furosemide and eplerenone

c) Eplerenone and captopril

d) Spironolactone and eplerenone

d) Spironolactone and eplerenone

In which type of heart failure are Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors recommended to reduce hospitalizations and cardiovascular mortality, regardless of the presence of type 2 diabetes?

a) Heart failure with preserved ejection fraction (HFpEF)

b) Heart failure with reduced ejection fraction (HFrEF)

c) Acute decompensated heart failure

d) Valvular heart disease

b) Heart failure with reduced ejection fraction (HFrEF)

True or False: Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors are only beneficial in heart failure patients with type 2 diabetes.

a) True

b) False

False

True or False: ACE inhibitors are indicated for all patients with heart failure with reduced ejection fraction (HFrEF) regardless of symptoms.

a) True

b) False

True

What is a notable advantage of loop diuretics in the management of heart failure, particularly in patients with reduced kidney function?

a) They directly improve cardiac contractility

b) They have a longer duration of action compared to other diuretics

c) They maintain effectiveness even with reduced creatinine clearance (CrCl)

d) They primarily act on the distal tubules in the kidney

c) They maintain effectiveness even with reduced creatinine clearance (CrCl)

Which loop diuretic has the highest potency when compared to furosemide, torsemide, and bumetanide?

a) Furesmide

b) Torsemide

c) Ethacrynic acid

d) Bumetanide

d) Bumetanide

What is the typical dose conversion ratio between furosemide and torsemide?

a) Ethacrynic acid 50 mg : Furosemide 40 mg

b) Furosemide 40 mg : Torsemide 20 mg

c) Torsemide 20 mg : Bumetanide 1 mg

d) Furosemide PO:IV 2:1

b) Furosemide 40 mg : Torsemide 20 mg

In heart failure with reduced ejection fraction (HFrEF), when might digoxin be considered for use?

a) To improve survival and reduce morbidity

b) To reduce the risk of sudden cardiac death

c) To decrease hospitalizations for heart failure

d) As first-line therapy for symptom relief

c) To decrease hospitalizations for heart failure