Heart Failure: Causes and Types

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Questions and Answers

What is the approximate 5-year mortality rate for heart failure?

  • 75%
  • 25%
  • 50% (correct)
  • 90%

What is the most common cause of heart failure in the USA?

  • Myocardial infarction
  • Cardiomyopathy
  • Coronary artery disease (correct)
  • Hypertension

In systolic failure, what is typically reduced?

  • Stroke volume
  • Ejection fraction (correct)
  • Cardiac output
  • All of the above

Which type of heart failure is more common in older patients?

<p>Diastolic failure (C)</p>
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What is a characteristic of diastolic failure?

<p>Stiffening and loss of adequate relaxation (D)</p>
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What is the trend in the prevalence of heart failure?

<p>Increasing (D)</p>
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What are the two primary goals of treatment in heart failure?

<p>Reducing symptoms and slowing progression (C)</p>
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What is the name of the plant family that provides medically useful cardiac glycosides?

<p>Digitalis (B)</p>
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What is the extent of absorption of digoxin after oral administration?

<p>65–80% (A)</p>
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Where are cardiac glycosides distributed in the body?

<p>Widely distributed to tissues, including the CNS (A)</p>
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How is digoxin primarily eliminated from the body?

<p>Excreted unchanged by the kidneys (C)</p>
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What is the relationship between digoxin's renal clearance and creatinine clearance?

<p>Directly proportional (A)</p>
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What is the primary mechanism by which cardiac glycosides increase cardiac contractility?

<p>Inhibition of Na+/K+-ATPase, leading to increased intracellular sodium concentration (B)</p>
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What is the result of the inhibition of Na+/K+-ATPase by cardiac glycosides?

<p>An increase in intracellular sodium concentration (C)</p>
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What is the role of the sodium-calcium exchanger in the mechanism of cardiac glycosides?

<p>It reduces calcium expulsion from the cell (D)</p>
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What is the effect of cardiac glycosides on the electrical properties of the heart?

<p>A mixture of direct and autonomic actions (D)</p>
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What is the mechanism by which cardiac glycosides increase the free calcium concentration in the vicinity of the contractile proteins?

<p>A two-step process involving Na+/K+-ATPase inhibition and the sodium-calcium exchanger (B)</p>
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What is the therapeutic effect of cardiac glycosides?

<p>Positive inotropy (B)</p>
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What is the primary effect of cardiac glycosides on the cardiac action potential?

<p>Early and brief prolongation of the action potential (D)</p>
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What is the main mechanism by which cardiac glycosides slow AV conduction?

<p>Increasing vagal outflow (D)</p>
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What is the consequence of an excessively rapid ventricular rate?

<p>Inadequate time for diastolic filling (B)</p>
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What is the effect of larger doses of glycosides on sinus rhythm?

<p>Disturbance of sinus rhythm (D)</p>
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What is the result of inhibition of the Na+/K+ pump by glycosides?

<p>Depolarization (A)</p>
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What is the potential consequence of slowing AV conduction by cardiac glycosides?

<p>AV block (C)</p>
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What is the consequence of increased [Ca2+]i in the cardiac muscle?

<p>Coupled beats followed by ventricular tachycardia and eventually ventricular fibrillation (D)</p>
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What is the primary site of digitalis toxicity outside the heart?

<p>Gastrointestinal tract (C)</p>
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What is the cause of gastrointestinal toxicity associated with digitalis?

<p>Both direct effects on the gastrointestinal tract and CNS actions (D)</p>
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What is a rare effect of digitalis in men?

<p>Gynecomastia (D)</p>
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What is a possible CNS effect of digitalis?

<p>Aberrations of color perception (A)</p>
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