Heart Failure Overview and Classification

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Questions and Answers

What is the primary benefit of using Digoxin in heart failure treatment?

Increases intracellular calcium concentration (correct)

Decreases heart rate significantly

Reduces heart muscle thickness

Lowers blood pressure

Which stage of heart failure is characterized by structural heart disease with symptoms present?

Stage D

Stage A

Stage B

Stage C (correct)

What condition is NOT commonly associated with leading to heart failure?

Valvular heart disease

Coronary artery disease

Hyperlipidemia (correct)

Hypertension

What is a consequence of compensatory mechanisms in heart failure over time?

Increased workload on the heart Signup and view all the answers

Which functional classification of heart failure allows patients to perform physical activity with no limitation?

Class I Signup and view all the answers

Which of the following is a contraindication for the use of Digoxin?

Heart block Signup and view all the answers

What effect does Digoxin have on renal perfusion?

Increases renal perfusion Signup and view all the answers

Which of the following adverse effects is most associated with Digoxin use?

Headache and weakness Signup and view all the answers

What is the largest risk factor in Class IV heart failure?

Symptoms at rest and inability to perform any physical activity Signup and view all the answers

Which of the following might reduce the effectiveness of Digoxin?

Low potassium levels Signup and view all the answers

What is the primary goal of treatment for heart failure?

Decrease the work on the heart Signup and view all the answers

Which of the following drugs is currently available as a phosphodiesterase inhibitor?

Milrinone Signup and view all the answers

What effect does milrinone have on cardiac function?

Increases levels of cAMP Signup and view all the answers

Which of the following is a common adverse effect of milrinone?

Arrhythmias Signup and view all the answers

What is Ivabradine primarily used to treat?

Chronic heart failure Signup and view all the answers

What is a contraindication for the use of Ivabradine?

Low blood pressure Signup and view all the answers

What combination of drugs does Entresto consist of?

Valsartan and sacubitril Signup and view all the answers

Which of the following is a potential adverse effect of Entresto?

Hyperkalemia Signup and view all the answers

Which of the following may interact negatively with Angiotensin Receptor Neprilysin Inhibitors?

ACE inhibitors Signup and view all the answers

What is a common adverse effect of taking Ivabradine?

Luminous phenomena Signup and view all the answers

Why should you assess for allergies before administering phosphodiesterase inhibitors?

Allergies can lead to severe reactions Signup and view all the answers

In what way does an Angiotensin Receptor Neprilysin Inhibitor function therapeutically?

Inhibits the effects of RAAS Signup and view all the answers

Which patient condition can be a contraindication for the use of Entresto?

History of angioedema related to ACE inhibitors Signup and view all the answers

What is a key assessment for a nurse when interacting with a patient on phosphodiesterase inhibitors?

Monitor cardiac status and heart sounds Signup and view all the answers

What could indicate a strong drug interaction when administering Ivabradine?

Strong CYP3A4 inducers Signup and view all the answers

Study Notes

Heart Failure

A condition where the heart cannot effectively pump blood throughout the body.
Caused by structural and/or functional irregularities.
Characterized by low cardiac output.
Divided into four stages:
- Stage A: High risk, no structural heart disease or symptoms.
- Stage B: Structural heart disease, no signs or symptoms.
- Stage C: Structural heart disease, prior or current symptoms.
- Stage D: Refractory, requiring specialized interventions.

Functional Classifications

Class I: No limitation of physical activity
Class II: Slight limitation of physical activity.
Class III: Marked limitation of physical activity.
Class IV: Unable to perform any physical activity without symptoms, or symptoms at rest.
Usually involves dysfunction of cardiac muscle.

Common Disorders Leading to Heart Failure

Coronary artery disease.
Cardiomyopathy.
Hypertension.
Valvular heart disease.

Compensatory Mechanisms

Decreased cardiac output stimulates:
- Sympathetic stimulation.
- Positive inotropic effect.
- Release of renin.
Over time, compensatory mechanisms increase heart workload:
- Muscle stretches and/or thickens.
- Chambers are unable to effectively pump blood.
- Leads to increased heart failure.

Treatments for Heart Failure

Cardiac glycosides.
Phosphodiesterase inhibitors.
Hyperpolarization-activated cyclic nucleotide-gated channel blockers.
Angiotensin receptor neprilysin inhibitors.

Cardiac Glycosides

Increase intracellular calcium during depolarization.
Increase the force of myocardial contraction.
Increase cardiac output and renal perfusion.
Slow heart rate.
Decrease conduction velocity.
Digoxin (Lanoxin) is used to treat HF symptoms.
Contraindications:
- Allergy
- Ventricular tachycardia or fibrillation.
- Heart block or sick sinus syndrome.
- Idiopathic hypertrophic subaortic stenosis.
- Acute MI.
- Renal insufficiency.
- Electrolyte abnormalities.

Phosphodiesterase Inhibitors

Milrinone (generic) is the only drug currently available in this class.
Blocks phosphodiesterase, leading to increase in cAMP, which increases calcium levels in the cell, causing a stronger contraction and prolonging effects of sympathetic stimulation.
Limited to severe situations.
Contraindications:
- Allergy.
- Severe aortic or pulmonic disease.
- Acute MI.
- Fluid volume deficit.
- Ventricular arrhythmias.

Hyperpolarization-Activated Cyclic Nucleotide–Gated Channel Blockers

Ivabradine (Corlanor).
Blocks HCNs, which slows the sinus node in the repolarizing phase of the action potential, leading to a reduction in heart rate.
Indications: Reduce the risk of hospitalization for worsening HF.
Contraindications:
- Known allergy.
- Active, decompensated HF.
- Hypotension.
- Sick sinus syndrome of AV block.
- Resting heart rate under 60 beats/min.
- Dependency on a pacemaker.
- Severe hepatic impairment.

Angiotensin Receptor Neprilysin Inhibitor

Entresto (an ARNI) is a combination of valsartan and sacubitril.
Blocks the breakdown of natriuretic peptides.
Inhibits the effects of RAAS.
Leads to decreased cardiac workload, lower vascular volume, lower blood pressure, improved HF symptoms.
Contraindications:
- Allergy.
- History of angioedema related to ACEI or ARB medication.
- Concurrent use with ACEI.
- Concurrent use with aliskiren.
- Pregnancy and lactation.

Nursing Considerations for Phosphodiesterase Inhibitors

Assess:
- History and physical examination.
- Known allergies, acute aortic or pulmonic valvular disease, acute MI or fluid volume deficit, and ventricular arrhythmias.
- Pregnancy and lactation.
- Cardiac status and heart sounds.
Drug–drug interactions: Furosemide.

Question #2

The nurse should assess the patient presenting with acute MI for signs and symptoms of HF, as MI is a known cause of HF.

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Description

This quiz covers the definition, stages, and functional classifications of heart failure. Learn about common disorders leading to heart failure, as well as compensatory mechanisms involved in the condition. Test your understanding of this critical cardiovascular topic.