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Questions and Answers
Which class of drugs is NOT used for the symptomatic treatment of angina?
Which class of drugs is NOT used for the symptomatic treatment of angina?
Chronic Kidney Disease (CKD) can be diagnosed with a GFR of 80 mL/min.
Chronic Kidney Disease (CKD) can be diagnosed with a GFR of 80 mL/min.
False
What is the gold standard for measuring kidney function?
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 __________.
Acute kidney injury is most often due to inadequate kidney blood pressure, also known as __________.
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Match the kidney disease stage to its description:
Match the kidney disease stage to its description:
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Which of the following is a potential consequence of chronic hyperglycemia?
Which of the following is a potential consequence of chronic hyperglycemia?
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Proteinuria indicates that there is no kidney damage present.
Proteinuria indicates that there is no kidney damage present.
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Name one class of potentially nephrotoxic drugs.
Name one class of potentially nephrotoxic drugs.
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What is orthopnea?
What is orthopnea?
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Inotropic drugs decrease cardiac contractility.
Inotropic drugs decrease cardiac contractility.
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What role do baroreceptors play in blood pressure regulation?
What role do baroreceptors play in blood pressure regulation?
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In heart failure, pulmonary edema is characterized by increased fluid in the ______ tissue.
In heart failure, pulmonary edema is characterized by increased fluid in the ______ tissue.
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Match the following inotropic drugs with their effects:
Match the following inotropic drugs with their effects:
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What happens if afterload increases?
What happens if afterload increases?
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Drugs that cause vasodilation will increase blood pressure.
Drugs that cause vasodilation will increase blood pressure.
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Explain the relationship between mean arterial pressure (MAP) and tissue perfusion.
Explain the relationship between mean arterial pressure (MAP) and tissue perfusion.
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Which of the following symptoms is commonly associated with left-sided heart failure?
Which of the following symptoms is commonly associated with left-sided heart failure?
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Heart failure with preserved ejection fraction (HFpEF) is defined as having an ejection fraction of less than 50%.
Heart failure with preserved ejection fraction (HFpEF) is defined as having an ejection fraction of less than 50%.
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What is the primary function of ARNI in the treatment of chronic heart failure?
What is the primary function of ARNI in the treatment of chronic heart failure?
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In heart failure, __________ is a common symptom characterized by fluid collection in the abdominal cavity.
In heart failure, __________ is a common symptom characterized by fluid collection in the abdominal cavity.
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Match the following symptoms with the type of heart failure they are associated with:
Match the following symptoms with the type of heart failure they are associated with:
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Which medication is preferred over ACE inhibitors and ARBs for heart failure treatment, despite potential cost concerns?
Which medication is preferred over ACE inhibitors and ARBs for heart failure treatment, despite potential cost concerns?
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In chronic heart failure, nocturia is a symptom that may indicate decreased renal perfusion.
In chronic heart failure, nocturia is a symptom that may indicate decreased renal perfusion.
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What is the goal of non-pharmacological management of heart failure?
What is the goal of non-pharmacological management of heart failure?
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What is the primary function of loop diuretics such as furosemide?
What is the primary function of loop diuretics such as furosemide?
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Thiazide diuretics cause a larger diuresis than loop diuretics.
Thiazide diuretics cause a larger diuresis than loop diuretics.
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Name a common adverse effect of loop diuretics.
Name a common adverse effect of loop diuretics.
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Potassium-sparing diuretics have a minimal effect on _______ ion excretion.
Potassium-sparing diuretics have a minimal effect on _______ ion excretion.
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Match the diuretic types with their characteristics:
Match the diuretic types with their characteristics:
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Which of the following is a major adverse effect of thiazide diuretics?
Which of the following is a major adverse effect of thiazide diuretics?
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Mannitol is commonly prescribed as a first-line treatment for hypertension.
Mannitol is commonly prescribed as a first-line treatment for hypertension.
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What is the net effect of diuretics on fluid volume?
What is the net effect of diuretics on fluid volume?
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What is considered a normal blood pressure classification?
What is considered a normal blood pressure classification?
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Which group is most prevalent in developing hypertension?
Which group is most prevalent in developing hypertension?
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Secondary hypertension accounts for less than 10% of hypertension cases.
Secondary hypertension accounts for less than 10% of hypertension cases.
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What are two common causes of secondary hypertension?
What are two common causes of secondary hypertension?
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Calcium channel blockers (CCBs) are used to treat __________ and hypertension.
Calcium channel blockers (CCBs) are used to treat __________ and hypertension.
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Match the following calcium channel blockers to their classifications:
Match the following calcium channel blockers to their classifications:
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What lifestyle change is recommended to manage hypertension?
What lifestyle change is recommended to manage hypertension?
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Angina pectoris is a type of cardiovascular event preceding myocardial infarction.
Angina pectoris is a type of cardiovascular event preceding myocardial infarction.
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What should be the first-line therapy for African American patients with hypertension?
What should be the first-line therapy for African American patients with hypertension?
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Inadequate blood flow leads to __________, which can be symptomatic of angina or myocardial infarction.
Inadequate blood flow leads to __________, which can be symptomatic of angina or myocardial infarction.
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Which medication type should NOT be used in conjunction with an ACE inhibitor?
Which medication type should NOT be used in conjunction with an ACE inhibitor?
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Dihydropyridine CCBs have more negative inotropic effects than nondihydropyridine CCBs.
Dihydropyridine CCBs have more negative inotropic effects than nondihydropyridine CCBs.
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Name a major adverse cardiovascular event (MACE) risk factor.
Name a major adverse cardiovascular event (MACE) risk factor.
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Match the following heart healthy lifestyle changes with their descriptions:
Match the following heart healthy lifestyle changes with their descriptions:
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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.
