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Questions and Answers
Which is a key update in heart failure terminology?
Which is a key update in heart failure terminology?
- Shifting from Acute Heart Failure to Chronic Heart Failure
- Shifting from Heart Failure to just Congestive Heart Failure
- Shifting from Congestive Heart Failure to just Heart Failure (correct)
- Shifting from Heart Failure to Cardiac Failure
What is the significance of the introduction of HFpEF and HFrEF?
What is the significance of the introduction of HFpEF and HFrEF?
- It helps in categorizing heart failure based on heart rhythm abnormalities
- It helps in categorizing heart failure based on blood pressure readings
- It helps in categorizing heart failure based on age of onset
- It helps in categorizing heart failure based on ejection fraction (correct)
What is the significance of the addition of the New York Heart Association Classification I-IV (NYHA) with structural ACCF/AHA Staging A to D?
What is the significance of the addition of the New York Heart Association Classification I-IV (NYHA) with structural ACCF/AHA Staging A to D?
- It emphasizes only the structural aspects of heart failure
- It focuses only on the functional aspects of heart failure
- It categorizes heart failure based on age of onset
- It provides a comprehensive assessment of heart failure severity (correct)
What is the paradigm shift from in the understanding of heart failure?
What is the paradigm shift from in the understanding of heart failure?
What is the focus of Guideline-directed medical therapy (GDMT) in heart failure management?
What is the focus of Guideline-directed medical therapy (GDMT) in heart failure management?
Which of the following is a key difference in the terminology used for heart failure?
Which of the following is a key difference in the terminology used for heart failure?
What is the focus of Therapeutic Strategies to Improve Morbidity in heart failure management?
What is the focus of Therapeutic Strategies to Improve Morbidity in heart failure management?
What is the paradigm shift in the understanding of heart failure?
What is the paradigm shift in the understanding of heart failure?
What is the significance of the introduction of HFpEF and HFrEF?
What is the significance of the introduction of HFpEF and HFrEF?
Which medication decreases systemic vascular resistance, leading to increased stroke volume and decreased afterload in heart failure?
Which medication decreases systemic vascular resistance, leading to increased stroke volume and decreased afterload in heart failure?
Which medication is contraindicated in acute decompensated heart failure but useful in slowing heart remodeling when heart failure is under control?
Which medication is contraindicated in acute decompensated heart failure but useful in slowing heart remodeling when heart failure is under control?
Which medication reduces preload and symptoms of congestion, and when combined with hydralazine, decreases mortality in heart failure?
Which medication reduces preload and symptoms of congestion, and when combined with hydralazine, decreases mortality in heart failure?
Which medication is an aldosterone receptor antagonist that improves mortality and morbidity in severe heart failure?
Which medication is an aldosterone receptor antagonist that improves mortality and morbidity in severe heart failure?
Which medication inhibits cell membrane NA/K-ATPase, leading to enhanced Ca$^{++}$ inside the cell?
Which medication inhibits cell membrane NA/K-ATPase, leading to enhanced Ca$^{++}$ inside the cell?
Which type of drugs are used for acute heart failure and chronic maintenance to maintain euvolemia?
Which type of drugs are used for acute heart failure and chronic maintenance to maintain euvolemia?
Which receptor subtype for angiotensin II must be diminished in heart failure, and is blocked by 'Sartan' drugs?
Which receptor subtype for angiotensin II must be diminished in heart failure, and is blocked by 'Sartan' drugs?
Which medication is an example of an ARB that has shown benefits for heart failure patients intolerant of ACE-I?
Which medication is an example of an ARB that has shown benefits for heart failure patients intolerant of ACE-I?
Which medication decreases preload and afterload, increases contractility, and does not increase heart rate?
Which medication decreases preload and afterload, increases contractility, and does not increase heart rate?
Which medication is a nonselective beta-blocker that improves symptoms, slows progression, and decreases hospitalizations and all-cause mortality in heart failure?
Which medication is a nonselective beta-blocker that improves symptoms, slows progression, and decreases hospitalizations and all-cause mortality in heart failure?
Which medication should seldom be used alone in heart failure, as monotherapy may cause adverse neurohormonal activation due to volume depletion?
Which medication should seldom be used alone in heart failure, as monotherapy may cause adverse neurohormonal activation due to volume depletion?
Which medication is an example of a drug that blocks the AT1 receptor subtype for angiotensin II?
Which medication is an example of a drug that blocks the AT1 receptor subtype for angiotensin II?
Which drug class is used to reduce the rate of cardiac remodeling in heart failure?
Which drug class is used to reduce the rate of cardiac remodeling in heart failure?
What effect does afterload reduction have on stroke volume in the failing heart?
What effect does afterload reduction have on stroke volume in the failing heart?
Which drug class is used for preload reduction in heart failure?
Which drug class is used for preload reduction in heart failure?
What is the major pathway for angiotensin II activation?
What is the major pathway for angiotensin II activation?
What is the primary effect of ACE inhibitors in heart failure treatment?
What is the primary effect of ACE inhibitors in heart failure treatment?
In which patients should ACE inhibitors be used according to the text?
In which patients should ACE inhibitors be used according to the text?
What is a common adverse effect of ACE inhibitors?
What is a common adverse effect of ACE inhibitors?
What should the choice of an ACE inhibitor be based on?
What should the choice of an ACE inhibitor be based on?
Which drug class is considered an alternative to ACE inhibitors in heart failure treatment?
Which drug class is considered an alternative to ACE inhibitors in heart failure treatment?
What effect do vasodilators have in heart failure treatment?
What effect do vasodilators have in heart failure treatment?
What is the primary function of aldosterone antagonists in heart failure treatment?
What is the primary function of aldosterone antagonists in heart failure treatment?
Which drug class is used to decrease resistance to outflow in heart failure?
Which drug class is used to decrease resistance to outflow in heart failure?
Which drug acts as an agonist at beta1 and dopamine1 receptors and is used for short-term therapy to increase splanchnic and renal blood flow?
Which drug acts as an agonist at beta1 and dopamine1 receptors and is used for short-term therapy to increase splanchnic and renal blood flow?
Which drug has indications for short-term therapy and its adverse effects include increased mortality in the long term?
Which drug has indications for short-term therapy and its adverse effects include increased mortality in the long term?
Which drug is the drug of choice in acute decompensated heart failure?
Which drug is the drug of choice in acute decompensated heart failure?
Which drug is a phosphodiesterase inhibitor and increases inward calcium flux in the heart?
Which drug is a phosphodiesterase inhibitor and increases inward calcium flux in the heart?
Which drug enhances contractility by increasing Ca++ concentrations and acting on Na-K ATPase and Na-Ca Exchange?
Which drug enhances contractility by increasing Ca++ concentrations and acting on Na-K ATPase and Na-Ca Exchange?
Which drug has mechanical effects on the heart, including increased myocardial contractile force and decreased duration of systole?
Which drug has mechanical effects on the heart, including increased myocardial contractile force and decreased duration of systole?
Which drug has electrical effects on the heart, such as slowing the sinus rate and indirect and direct effects on AV node and Purkinje fibers?
Which drug has electrical effects on the heart, such as slowing the sinus rate and indirect and direct effects on AV node and Purkinje fibers?
Which drug is a beta1 and beta2 agonist and is used for short-term support of cardiac output in advanced heart failure?
Which drug is a beta1 and beta2 agonist and is used for short-term support of cardiac output in advanced heart failure?
Which drug is a neutral endopeptidase involved in the metabolism of vasoactive peptides and its inhibition results in higher levels of peptides with vasodilator properties?
Which drug is a neutral endopeptidase involved in the metabolism of vasoactive peptides and its inhibition results in higher levels of peptides with vasodilator properties?
Which drug is used for short-term therapy and increases inward calcium flux in the heart?
Which drug is used for short-term therapy and increases inward calcium flux in the heart?
Which drug is a beta1 and beta2 agonist and increases cardiac output?
Which drug is a beta1 and beta2 agonist and increases cardiac output?
Which drug is involved in the metabolism of vasoactive peptides and its inhibition results in higher levels of peptides with vasodilator properties?
Which drug is involved in the metabolism of vasoactive peptides and its inhibition results in higher levels of peptides with vasodilator properties?
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Study Notes
Inotropic Drugs and Heart Failure Treatments
- Digoxin enhances contractility by increasing Ca++ concentrations and acting on Na-K ATPase and Na-Ca Exchange
- Digoxin has mechanical effects on the heart, including increased myocardial contractile force and decreased duration of systole
- Digoxin has electrical effects on the heart, such as slowing the sinus rate and indirect and direct effects on AV node and Purkinje fibers
- Digoxin has extracardiac effects and toxicities, including GI symptoms, mental symptoms, and vision disturbances
- Milrinone, a phosphodiesterase inhibitor, increases inward calcium flux in the heart and inhibits cAMP phosphodiesterase
- Milrinone's indications include short-term therapy and its adverse effects are fewer in the short term but include increased mortality in the long term
- Dobutamine, a beta1 and beta2 agonist, increases cardiac output and is used for short-term support of cardiac output in advanced heart failure
- Dopamine acts as an agonist at beta1 and dopamine1 receptors and is used for short-term therapy to increase splanchnic and renal blood flow
- Dobutamine is the drug of choice in acute decompensated heart failure, while dopamine is preferred in some situations with low blood pressure
- New treatments for heart failure include Corlanor (Ivabradine) and the PARADIGM-HF trial for Angiotensin-receptor and neprilysin inhibition with Entresto™ (sacubitril and valsartan)
- Neprilysin is a neutral endopeptidase involved in the metabolism of vasoactive peptides and its inhibition results in higher levels of peptides with vasodilator properties
- Neprilysin substrates relevant to cardiovascular physiology include ANP, BNP, CNP, Ang-II, adrenomedullin, substance P, bradykinin, endothelin, and urodilatin
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