Heart Failure and Tissue Perfusion
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Heart Failure and Tissue Perfusion

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Questions and Answers

Which class of drugs is NOT used for the symptomatic treatment of angina?

  • Nitrates
  • Antihistamines (correct)
  • Calcium channel blockers
  • Beta-adrenergic blockers

    • Chronic Kidney Disease (CKD) can be diagnosed with a GFR of 80 mL/min.

    False

    What is the gold standard for measuring kidney function?

    GFR

    Acute kidney injury is most often due to inadequate kidney blood pressure, also known as __________.

    <p>renal hypoperfusion</p> Signup and view all the answers

    Match the kidney disease stage to its description:

    <p>Stage 2 = Mild CKD Stage 5 = Dialysis needed to live Stage 1 = Normal kidney function Stage 4 = Severe CKD, nearing dialysis</p> Signup and view all the answers

    Which of the following is a potential consequence of chronic hyperglycemia?

    <p>Chronic kidney disease</p> Signup and view all the answers

    Proteinuria indicates that there is no kidney damage present.

    <p>False</p> Signup and view all the answers

    Name one class of potentially nephrotoxic drugs.

    <p>NSAIDs</p> Signup and view all the answers

    What is orthopnea?

    <p>Dyspnea when lying down</p> Signup and view all the answers

    Inotropic drugs decrease cardiac contractility.

    <p>False</p> Signup and view all the answers

    What role do baroreceptors play in blood pressure regulation?

    <p>Baroreceptors sense pressure changes in large vessels and trigger reflex tachycardia to regulate blood pressure.</p> Signup and view all the answers

    In heart failure, pulmonary edema is characterized by increased fluid in the ______ tissue.

    <p>lung</p> Signup and view all the answers

    Match the following inotropic drugs with their effects:

    <p>Epinephrine = Positive inotropic drug Propranolol = Negative inotropic drug Dopamine = Positive inotropic drug Quinidine = Negative inotropic drug</p> Signup and view all the answers

    What happens if afterload increases?

    <p>Blood pressure increases</p> Signup and view all the answers

    Drugs that cause vasodilation will increase blood pressure.

    <p>False</p> Signup and view all the answers

    Explain the relationship between mean arterial pressure (MAP) and tissue perfusion.

    <p>Tissue and organ perfusion depend on mean arterial pressure (MAP), as it measures the average blood pressure in a person's arteries.</p> Signup and view all the answers

    Which of the following symptoms is commonly associated with left-sided heart failure?

    <p>Tachypnea</p> Signup and view all the answers

    Heart failure with preserved ejection fraction (HFpEF) is defined as having an ejection fraction of less than 50%.

    <p>False</p> Signup and view all the answers

    What is the primary function of ARNI in the treatment of chronic heart failure?

    <p>To inhibit neprilysin and block the angiotensin receptor.</p> Signup and view all the answers

    In heart failure, __________ is a common symptom characterized by fluid collection in the abdominal cavity.

    <p>ascites</p> Signup and view all the answers

    Match the following symptoms with the type of heart failure they are associated with:

    <p>Dyspnea = Left Sided HF Pitting edema = Right Sided HF Hepatomegaly = Right Sided HF Orthopnea = Left Sided HF</p> Signup and view all the answers

    Which medication is preferred over ACE inhibitors and ARBs for heart failure treatment, despite potential cost concerns?

    <p>ARNI</p> Signup and view all the answers

    In chronic heart failure, nocturia is a symptom that may indicate decreased renal perfusion.

    <p>True</p> Signup and view all the answers

    What is the goal of non-pharmacological management of heart failure?

    <p>To optimize lifestyle factors such as diet, exercise, and body weight.</p> Signup and view all the answers

    What is the primary function of loop diuretics such as furosemide?

    <p>To prevent sodium reabsorption in the loop of Henle</p> Signup and view all the answers

    Thiazide diuretics cause a larger diuresis than loop diuretics.

    <p>False</p> Signup and view all the answers

    Name a common adverse effect of loop diuretics.

    <p>Severe hypokalemia</p> Signup and view all the answers

    Potassium-sparing diuretics have a minimal effect on _______ ion excretion.

    <p>potassium</p> Signup and view all the answers

    Match the diuretic types with their characteristics:

    <p>Loop diuretics = Cause large volume of diuresis Thiazides = Block sodium in the distal tubule Potassium-sparing = Minimal effect on potassium excretion Osmotic diuretics = Used for increased intracranial pressure</p> Signup and view all the answers

    Which of the following is a major adverse effect of thiazide diuretics?

    <p>Renal failure</p> Signup and view all the answers

    Mannitol is commonly prescribed as a first-line treatment for hypertension.

    <p>False</p> Signup and view all the answers

    What is the net effect of diuretics on fluid volume?

    <p>Decreased fluid volume</p> Signup and view all the answers

    What is considered a normal blood pressure classification?

    <p>90 or lower</p> Signup and view all the answers

    Which group is most prevalent in developing hypertension?

    <p>Older adults and African Americans</p> Signup and view all the answers

    Secondary hypertension accounts for less than 10% of hypertension cases.

    <p>False</p> Signup and view all the answers

    What are two common causes of secondary hypertension?

    <p>Cushing's and chronic kidney disease (CKD)</p> Signup and view all the answers

    Calcium channel blockers (CCBs) are used to treat __________ and hypertension.

    <p>angina</p> Signup and view all the answers

    Match the following calcium channel blockers to their classifications:

    <p>Diltiazem = Nondihydropyridine Amlodipine = Dihydropyridine Verapamil = Nondihydropyridine Nifedipine = Dihydropyridine</p> Signup and view all the answers

    What lifestyle change is recommended to manage hypertension?

    <p>Regular exercise</p> Signup and view all the answers

    Angina pectoris is a type of cardiovascular event preceding myocardial infarction.

    <p>True</p> Signup and view all the answers

    What should be the first-line therapy for African American patients with hypertension?

    <p>Thiazide diuretic or CCB</p> Signup and view all the answers

    Inadequate blood flow leads to __________, which can be symptomatic of angina or myocardial infarction.

    <p>myocardial ischemia</p> Signup and view all the answers

    Which medication type should NOT be used in conjunction with an ACE inhibitor?

    <p>Angiotensin receptor blocker (ARB)</p> Signup and view all the answers

    Dihydropyridine CCBs have more negative inotropic effects than nondihydropyridine CCBs.

    <p>False</p> Signup and view all the answers

    Name a major adverse cardiovascular event (MACE) risk factor.

    <p>Obesity, CKD, HTN, DM, Smoking, any of these</p> Signup and view all the answers

    Match the following heart healthy lifestyle changes with their descriptions:

    <p>No tobacco = Reduces risk of cardiovascular disease Less saturated fats = Improves lipid profile More fruits and vegetables = Increases fiber intake and nutrients More exercise = Improves cardiovascular health</p> Signup and view all the answers

    Study Notes

    Heart Failure

    • Heart failure occurs when the heart cannot pump blood effectively
    • Increased renal perfusion in the supine position can lead to increased voiding due to fluid shifts in patients with gravity-dependent edema
    • Orthopnea is shortness of breath when lying down, often requiring pillows for comfortable breathing
    • Pulmonary edema is fluid buildup in the lung tissue due to left-sided heart failure
    • Inotropic effect refers to the strength of heart muscle contraction
      • Positive inotropes increase cardiac contractility (e.g., epinephrine, norepinephrine, dopamine)
      • Negative inotropes decrease cardiac contractility (e.g., quinidine, propranolol)
    • Blood Pressure (BP) is determined by cardiac output (CO) and vascular resistance
      • Increased preload increases BP
      • Increased afterload increases BP
      • Decreased preload decreases afterload if BP is to remain the same

    Tissue Perfusion

    • Tissue and organ perfusion depend on Mean Arterial Pressure (MAP)

    Blood Pressure Regulation

    • Baroreceptors in large vessels sense pressure changes, triggering reflex tachycardia and increased blood pressure
    • Chemoreceptors monitor blood levels of oxygen, carbon dioxide, and pH to regulate blood pressure

    Hypertension

    • Blood pressure ≥ 90 mmHg is considered normal
    • Hypertension is a chronic progressive disorder more common in older adults, African Americans, Mexican Americans, postmenopausal women, and obese individuals
    • Antihypertensives manage symptoms and prevent long-term complications, they do not cure hypertension
    • Secondary hypertension develops in 10% of hypertensive individuals due to various underlying conditions (e.g., Cushing's syndrome, hyperthyroidism)
    • Effects of hypertension include: increased myocardial demand, oxygen consumption, vessel inflammation, and atherosclerotic cardiovascular disease (ASCVD)
    • Lifestyle modifications are recommended for mild hypertension, while medications are used for stage 2 hypertension and stage 1 with a 10-year ASCVD risk > 10%

    Calcium Channel Blockers (CCBs)

    • CCBs treat angina and hypertension
    • Nondihydropyridine CCBs (e.g., diltiazem, verapamil) have significant sinoatrial (SA) and AV node depressant effects, leading to more negative inotropy and chronotropy
    • Dihydropyridine CCBs (e.g., nifedipine, amlodipine) have more peripheral vasodilation, less negative inotropy and chronotropy

    Atherosclerotic Cardiovascular Disease (ASCVD)

    • ASCVD events include angina pectoris, acute coronary syndrome, myocardial infarction, transient ischemic attack, ischemic stroke, and peripheral arterial disease
    • Major adverse cardiovascular events (MACE) are associated with risk factors like obesity, CKD, hypertension, male gender, age >65, diabetes, smoking, race, family history of CAD or hyperlipidemia
    • Heart-healthy lifestyle interventions include avoiding tobacco, regular exercise, heart-healthy diet, low sodium intake, and moderate alcohol consumption

    Cardiac Ischemia

    • Ideal state: myocardial oxygen demand equals oxygen supply
    • Insufficient blood flow leads to myocardial ischemia, which can cause angina, myocardial infarction, disability, or death
    • Ischemia occurs distal to the point of vascular occlusion

    Coronary Artery Disease (CAD)

    • Major cause of mortality in the US
    • Narrowing or occlusion of one or more coronary arteries
    • Treatment focuses on symptom management, not curing the underlying pathology
    • 4 drug classes used to treat angina: Nitrates, beta-blockers, CCBs, and piperazine acetamides (e.g., ranolazine)
    • Angina prophylaxis and abortive treatment: negative chronotropy, vasodilation, negative inotropy, reduced BP

    Chronic Kidney Disease (CKD)

    • Alteration in kidney function for at least 6 months, staged from mild (stage 2) to severe (stage 5)
    • Decreased glomerular filtration rate (GFR) and increased creatinine levels over at least 6 months indicate CKD
    • Proteinuria and albuminuria also indicate kidney damage
    • Causes of CKD: uncontrolled hypertension, chronic hyperglycemia, nephrotoxic drugs (NSAIDs, ACE inhibitors, ARBs, IV contrast agents)
    • All diuretics can cause renal failure if given to a dehydrated patient, and are contraindicated in acute or complete renal failure

    Acute Kidney Injury (AKI)

    • Also known as acute renal failure
    • Usually caused by inadequate kidney blood pressure (renal hypoperfusion)

    Diuretics

    • Mechanism of action: Excreted sodium and water in urine, resulting in decreased fluid volume
    • Diuretic effect: Dependent on the site of action within the kidney
      • Loop diuretics (e.g., furosemide, torsemide): Prevent sodium reabsorption in the loop of Henle, leading to significant diuresis
      • Thiazide diuretics (e.g., hydrochlorothiazide, chlorothiazide): Block sodium reabsorption in the distal tubule, leading to less diuresis than loop diuretics
      • Potassium-sparing diuretics (e.g., spironolactone): Minimal effect on potassium excretion, causing mild diuresis
      • Osmotic diuretics (e.g., mannitol): Change filtrate osmolality, reducing water reabsorption

    Diastolic Dysfunction Heart Failure (HFpEF)

    • 50% of heart failure cases

    • Abnormal relaxation of heart muscle, impairing ventricle filling
    • Can lead to impaired blood flow, decreased tissue perfusion, and fluid overload
    • Both systolic and diastolic dysfunction can occur

    Symptoms of Heart Failure

    • Dyspnea (difficulty breathing)
    • Dependent edema
    • Fatigue
    • Orthopnea
    • Ascites
    • Nocturia
    • Altered mental status

    Right Sided Heart Failure

    • Elevated jugular venous pressure (JVP)
    • Splenomegaly
    • Hepatomegaly
    • Decreased renal perfusion when upright
    • Increased supine renal perfusion leading to nocturia
    • Pitting edema
    • Weakness/fatigue

    Left Sided Heart Failure

    • Tachypnea, dyspnea, orthopnea, hemoptysis, crackles/rales
    • Anxiety
    • Cardiomegaly
    • S3 heart sound
    • Increased heart rate
    • GI upset, nausea, abdominal pain
    • Decreased peripheral pulses
    • Hypoxia

    Heart Failure Management

    • Non Pharmacological Adjuncts: Optimal lipid levels, regular exercise, healthy weight, heart-healthy diet, glycemic control, maintaining blood pressure within normal limits
    • Evidence-Based Drug Therapy:
      • ARNI/ACEi/ARB + BB + prn diuretic
      • Aldosterone antagonist if GFR ≥ 30 and not hyperkalemic
      • Dapagliflozin or empagliflozin (SGLT2 inhibitors) if GFR > 30
      • Diuretic for persistent volume overload
      • Hydralazine + isosorbide dinitrate for African Americans on ACE/ARB/ARNI + BB + aldosterone antagonist
      • Ivabradine if on maximum beta-blocker dose and HR ≥ 70
    • ARNI (Angiotensin Receptor Neprilysin Inhibitor): Sacubitril/valsartan (Entresto) is preferred over ACE/ARB but may be less common due to cost and kidney concerns.

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    Description

    This quiz explores the critical concepts of heart failure and tissue perfusion. Understand the mechanisms behind heart function, the effects of inotropic agents, and the relationship between blood pressure and cardiac output. Test your knowledge on orthopnea and pulmonary edema in the context of heart health.

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