Heart Failure Overview and Classification

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Questions and Answers

Which side effect is specifically associated with both Verapamil and Adenosine?

Hypotension

AV block

Bronchoconstriction

Constipation (correct)

Which agent is considered the drug of choice (DOC) for supraventricular tachycardia (SVT)?

Diltiazem

Adenosine (correct)

Verapamil

Magnesium Sulfate

Which of the following agents has the potential for causing pulmonary fibrosis as a side effect?

Bretylium

Sotalol

Encainide

Amiodarone (correct)

What is the primary use of Dronedarone in cardiac treatment?

First line for atrial fibrillation Signup and view all the answers

Which of the following is a cardinal symptom of heart failure?

Fluid Retention (Edema) Signup and view all the answers

What unique effect does the Wolff-Chaikoff Effect initially cause?

Hypothyroidism Signup and view all the answers

What is the primary impact of systolic heart failure?

Impaired degree of ventricular contraction Signup and view all the answers

Which class of the New York Heart Association (NYHA) classification denotes marked limitation of physical activity?

Class III Signup and view all the answers

What compensatory physiological response is NOT typically observed in heart failure?

Decreased blood volume Signup and view all the answers

Which of the following represents left-sided heart failure?

Pulmonary edema Signup and view all the answers

Which drug class is primarily used to decrease preload in heart failure management?

Diuretics Signup and view all the answers

In diastolic heart failure, what pathological condition is primarily responsible?

Stiffness of the cardiac muscle Signup and view all the answers

Which therapeutic goal aims to increase the force of myocardial contraction in heart failure treatment?

Increase cardiac inotropy Signup and view all the answers

What is the mechanism of action of nesiritide in treating acute heart failure?

Increases cGMP levels in smooth muscle cells Signup and view all the answers

Which of the following statements about digitalis glycosides is true?

Digoxin has low protein binding and is primarily cleared by the kidneys. Signup and view all the answers

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

Yellowish vision (xanthopsia) Signup and view all the answers

What is the main effect of beta-adrenergic agonists like dobutamine in acute heart failure management?

Activate B1 receptors to increase cAMP Signup and view all the answers

Which of the following is the primary use of phosphodiesterase inhibitors in heart failure?

Management of acute heart failure and CHF exacerbations Signup and view all the answers

Which class of medications is considered first-line therapy for heart failure?

ACE inhibitors Signup and view all the answers

What is a common side effect associated with β-adrenergic agonists?

Hypersensitivity reactions Signup and view all the answers

What effect do vasodilators have on afterload?

Reduce afterload Signup and view all the answers

What is a potential side effect of spironolactone?

Gynecomastia Signup and view all the answers

Which of the following is a first-line treatment for digoxin-induced ventricular tachycardia?

Lidocaine Signup and view all the answers

What class of antiarrhythmic drugs is primarily involved in sodium channel blockade?

Class IA Signup and view all the answers

Which drug is categorized as an ARB and can be used if a patient is intolerant to ACE inhibitors?

Losartan Signup and view all the answers

Which of the following is a common side effect of quinidine?

Cinchonism Signup and view all the answers

What should be monitored regularly in patients taking diuretics?

Potassium levels Signup and view all the answers

What clinical indication is Procainamide primarily used for?

Acute treatment of AF, VF, and VT Signup and view all the answers

Which medication is used as part of the UNLOAD FAST method to decrease fluid overload?

Furosemide Signup and view all the answers

Study Notes

Heart Failure

Heart Failure (HF) is a progressive disorder where the heart cannot pump sufficient blood to meet the body's needs.
Cardinal symptoms include dyspnea, fatigue, lethargy, and fluid retention (edema) leading to congestion.

Compensatory Responses

Increased sympathetic nervous system activity.
Activation of the Renin-Angiotensin-Aldosterone System (RAAS).
Myocardial hypertrophy occurs as an adaptive response.

Types of Heart Failure

Left-sided HF causes pulmonary edema.
Right-sided HF leads to peripheral edema.
Diastolic Heart Failure (preserved ejection fraction): ventricles can't fill due to stiffness.
Systolic Heart Failure (reduced ejection fraction): impaired ventricular contraction reduces cardiac output.

NYHA Classification

Class I: No limitations; comfortable at rest, ordinary activity causes symptoms.
Class II: Slight physical activity limitation; comfortable at rest.
Class III: Marked limitation; less-than-ordinary activity leads to symptoms.
Class IV: Unable to perform any activity without discomfort; symptoms at rest.

Therapeutic Goals

Increase myocardial contraction force.
Decrease heart workload.

Pharmacological Treatment for Heart Failure

Unloaders:
- ACE inhibitors, ARBs, aldosterone antagonists, diuretics decrease preload and fluid retention.
- Furosemide is a key diuretic.
- Vasodilators like Hydralazine and ISDN reduce afterload.
- Nesiritide used in acute HF to promote diuresis.
Inotropic Agents:
- Digitalis glycosides (e.g., Digoxin, Digitoxin) enhance contractility.
- β-Adrenergic agonists like Dobutamine and dopamine increase inotropy.
- Phosphodiesterase inhibitors (e.g., Amrinone, Milrinone) improve symptoms during acute HF exacerbation.

Cardiac Glycosides

Digoxin inhibits Na/KATPase, leading to increased intracellular calcium.
Digoxin: low protein binding, renal clearance, shorter half-life; Digitoxin: high protein binding, longer half-life.
Toxicity managed by correcting electrolyte imbalances, administering Digifab/Digibind, or using antiarrhythmics.

Beta-Blockers

First-line therapy includes metoprolol, carvedilol, and bisoprolol.
Administer with caution and titrate slowly due to reduced cardiovascular remodeling.

Other Treatment Options

Aldosterone antagonists (Spironolactone, Eplerenone) may cause gynecomastia and hyperkalemia.
ARBs used if ACE inhibitors are intolerable.
Nitrates and hydralazine employed when ACEi and ARBs are not suitable.

Emergency Management ("UNLOAD FAST")

Upright position and low-dose nitrates.
Administer Lasix (Furosemide) and oxygen therapy.
May consider aminophylline, digoxin, or decreasing fluids and afterload.

Monitoring

Key tests include arterial blood gas (ABG), potassium levels, and glucose.

Antiarrhythmics

Heart arrhythmias disrupt normal electrical impulses in the heart.

Treatment Goals for Arrhythmias

Sodium channel blockade and inhibition of sympathetic innervation.
Prolong effective refractory period through potassium channel blockade and calcium channel blockade.

Vaughan-Williams Classification

Class I (Sodium Channel Blockers):
- IA: Disopyramide, Quinidine, Procainamide (used in acute AF, VF, and VT).
- IB: Lidocaine (1st-line for digoxin-induced VT).
- IC: Flecainide and Propafenone (AE: metallic taste, constipation).
Class II (Beta Blockers):
- Exclude sotalol, used for arrhythmia management.
Class III (Potassium Channel Blockers):
- Amiodarone is a prime option, but may lead to hepatotoxicity and pulmonary fibrosis.
Class IV (Calcium Channel Blockers):
- Diltiazem and Verapamil used for SVT, with side effects like constipation and hypotension.
Miscellaneous Agents:
- Adenosine for SVT and Magnesium Sulfate for Torsades de Pointes and digitalis-induced arrhythmia.

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Description

This quiz covers the key concepts of Heart Failure (HF), including its symptoms, compensatory responses, and types. It also includes the NYHA classification system for assessing the severity of heart failure. Test your knowledge about the mechanisms and classifications used in the management of heart failure.