Heart Failure Quiz
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Questions and Answers

What is the primary reason for left-sided heart failure?

  • Peripheral edema
  • Myocardial infarction
  • Hypertrophy of the right ventricle
  • Blood accumulation in the left ventricle (correct)

    • Which of the following diseases is NOT commonly associated with heart failure?

  • Diabetes mellitus
  • Asthma (correct)
  • Hypertension
  • Coronary artery disease (CAD)

    • What term describes the stretching of myocardial fibers before contraction?

  • Hypertrophy
  • Afterload
  • Preload (correct)
  • Contractility

    • Which pharmacologic mechanism helps in managing heart failure by increasing the strength of heart contractions?

    <p>Increasing contractility</p> Signup and view all the answers

    What is the effect of lowering blood pressure in relation to afterload?

    <p>Reduces workload for the heart</p> Signup and view all the answers

    Which symptom is primarily associated with left-sided heart failure?

    <p>Cough and shortness of breath</p> Signup and view all the answers

    What is the primary objective of heart failure pharmacologic management?

    <p>Slow heart rate, increase contractility, reduce workload</p> Signup and view all the answers

    Right-sided heart failure is less common than which type of heart failure?

    <p>Left-sided heart failure</p> Signup and view all the answers

    What treatment is recommended for patients in Stage A of heart failure?

    <p>Lifestyle modifications and treatment of comorbid conditions</p> Signup and view all the answers

    Which class of patients is included in Stage B of heart failure?

    <p>Patients with structural heart disease but no symptoms</p> Signup and view all the answers

    In Stage C of heart failure, what are the typical symptoms experienced by patients?

    <p>Fatigue, fluid retention, and dyspnea</p> Signup and view all the answers

    What is the first-line pharmacological treatment option for patients in Stage C?

    <p>ACE inhibitors or ARB</p> Signup and view all the answers

    Which treatment might be added for Stage C heart failure patients if symptoms persist?

    <p>Aldosterone antagonist</p> Signup and view all the answers

    What characterizes Stage D heart failure?

    <p>Symptoms at rest or with minimal exertion despite treatment</p> Signup and view all the answers

    Which of the following is a primary action of ACE inhibitors in treating heart failure?

    <p>Reduce peripheral resistance and lower blood volume</p> Signup and view all the answers

    What is a secondary treatment added during Stage D management for symptom relief?

    <p>IV diuretics or other inotropes</p> Signup and view all the answers

    What is the primary mechanism of action for lisinopril?

    <p>Decrease aldosterone secretion</p> Signup and view all the answers

    What is a common adverse effect associated with the use of ACE inhibitors?

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

    In what scenario are Angiotensin II Receptor Blockers (ARBs) typically prescribed?

    <p>When patients cannot tolerate ACE inhibitors</p> Signup and view all the answers

    What is the primary effect of diuretics in treating cardiovascular conditions?

    <p>Reduce blood volume</p> Signup and view all the answers

    What is the prototype drug for cardiac glycosides?

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

    Which of the following is an adverse effect of digoxin?

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

    How do beta-adrenergic blockers primarily affect the heart?

    <p>Decrease heart workload</p> Signup and view all the answers

    What is a potential adverse effect of using beta-adrenergic blockers?

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

    What is the primary action of direct vasodilators in the treatment of heart failure?

    <p>Relax blood vessels</p> Signup and view all the answers

    What is a common adverse effect associated with phosphodiesterase inhibitors?

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

    What is the main therapeutic use of phosphodiesterase inhibitors?

    <p>Short-term therapy for heart failure</p> Signup and view all the answers

    What should a patient do if they experience a pulse below 50 while taking heart failure medications?

    <p>Consult a healthcare provider immediately</p> Signup and view all the answers

    Which dietary modification is recommended for patients taking medications for heart failure?

    <p>Monitor sodium intake</p> Signup and view all the answers

    What laboratory monitoring is needed for patients receiving heart failure medications?

    <p>Therapeutic levels</p> Signup and view all the answers

    What symptom should a patient taking heart failure medication report as a sign of potential toxicity?

    <p>Fast weight gain</p> Signup and view all the answers

    What should be done if a patient receiving intravenous medications experiences pain or swelling at the infusion site?

    <p>Immediately report the symptoms</p> Signup and view all the answers

    Study Notes

    Heart Failure (HF)

    • Inability of ventricles to pump enough blood for the body's needs
    • Weakening of the heart muscle due to aging or disease.

    Diseases Associated with Heart Failure

    • Coronary artery disease (CAD)
    • Mitral stenosis
    • Myocardial infarction (MI)
    • Chronic hypertension (HTN)
    • Diabetes mellitus
    • No cure, only prevention and slowing of progression

    Left-Sided Heart Failure

    • Blood accumulates in the left ventricle
    • Left ventricle thickens and enlarges (hypertrophy)
    • Cardiac remodeling
    • Blood backs up into the lungs
    • Cough and shortness of breath result

    Right-Sided Heart Failure

    • Blood backs up into veins
    • Causes peripheral edema and organ engorgement
    • Less common than left-sided HF

    Pathophysiology of Heart Failure

    • Failing heart: decreased cardiac output
    • Diminished renal blood flow
    • Vasoconstriction: increased blood pressure
    • Activation of renin-angiotensin-aldosterone system
    • Retention of sodium and water
    • Increased plasma volume
    • Increased cardiac workload
    • Myocardial dysfunction: worsening heart failure
    • Pulmonary and peripheral edema

    Preload

    • Affects cardiac output
    • Degree myocardial fibers are stretched prior to contraction
    • Frank-Starling law: More stretched fibers, more forceful contraction
    • Drugs that increase preload contractility increase cardiac output (Positive inotropic agents)

    Afterload

    • Affects cardiac output
    • Pressure in aorta that must be overcome before blood is ejected from the left ventricle
    • Lowering blood pressure creates less afterload, resulting in less workload for the heart

    Pharmacologic Management of Heart Failure

    • Mechanisms:
      • Slowing the heart rate
      • Increasing contractility
      • Reducing myocardial workload

    Drugs for Heart Failure

    • Treat symptoms:
      • Slow heart rate
      • Increase contractility
      • Reduce heart workload

    Stages for Treating Heart Failure

    • (1 of 2)*

    • Stage A: High risk of developing HF without structural heart disease or symptoms. Lifestyle modifications, treat comorbid conditions such as HTN, dyslipidemia, and diabetes.

    • Stage B: Structural evidence of heart disease but no symptoms(NYHA Class I). Continue prior lifestyle modifications, and treat with ACE inhibitor or ARB. Beta blockers may be added.

    • (2 of 2)*

    • Stage C: Structural evidence with symptoms such as fatigue, fluid retention, or dyspnea (NYHA Class II and III). Continue lifestyle modifications, ACE inhibitor or ARB or Entresto. Add beta blocker, isosorbide dinitrate with hydralazine, digoxin, or an aldosterone antagonist if necessary.

    • Stage D: Symptoms at rest or during minimal exertion despite optimal medical therapy (NYHA Class IV). Continue lifestyle modifications, and may include ivabradine, IV diuretics, dopamine, dobutamine, IV nitroglycerin, nitroprusside, nesiritide, or phosphodiesterase inhibitors.

    ACE Inhibitors (1 of 2)

    • Reduce afterload
    • Drugs of choice for heart failure
    • Enhance sodium and water excretion
    • Lower peripheral resistance and reduce blood volume
    • Increase cardiac output

    ACE Inhibitors (2 of 2)

    • Prototype drug: lisinopril (Prinivil, Zestril)
    • Mechanism of action: inhibit ACE enzyme and decrease aldosterone secretion
    • Primary use: decrease blood pressure and reduce blood volume, dilate veins
    • Adverse effects: first-dose hypotension, cough, hyperkalemia, renal failure

    Angiotensin II Receptor Blockers (ARBs)

    • Actions very similar to ACE inhibitors
    • Usually used for patients who can't tolerate ACE inhibitor adverse effects

    Diuretics

    • Increase urine flow
    • Reduce blood volume and cardiac workload
    • Reduce edema and pulmonary congestion
    • Prescribed in combination with other drugs

    Cardiac Glycosides (1 of 2)

    • Increase force of heartbeat, slow heart rate
    • Improve cardiac output
    • Second-line treatment for HF
    • Narrow therapeutic range.

    Cardiac Glycosides (2 of 2)

    • Prototype drug: digoxin (Lanoxin)
    • Mechanism of action: cause more forceful heartbeat, slower heart rate
    • Primary use: increase contractility or strength of myocardial contraction
    • Adverse effects: neutropenia, dysrhythmias, digitalis toxicity

    Beta-Adrenergic Blockers (1 of 3)

    • Slow heart rate and reduce blood pressure
    • Inotropic effect
    • Reduce workload of heart

    Beta-Adrenergic Blockers (2 of 3)

    • Prototype drug: metoprolol (Lopressor, Troprol XL)
    • Mechanism of action: block cardiac action of the sympathetic nervous system to slow heart rate and BP, reducing workload of heart

    Beta-Adrenergic Blockers (3 of 3)

    • Primary use: reduce symptoms of heart failure and slow progression of disease
    • Adverse effects: fluid retention, worsening of heart failure, fatigue, hypotension, bradycardia, heart block

    Direct Vasodilators

    • Minor role in HF treatment
    • Lower blood pressure
    • Relax blood vessels

    Phosphodiesterase Inhibitors (1 of 2)

    • Block enzyme phosphodiesterase
    • Increase calcium for myocardial contraction
    • Cause positive inotropic response and vasodilation
    • Increase contractility and decrease afterload
    • Short-term therapy only

    Phosphodiesterase Inhibitors (2 of 2)

    • Prototype drug: milrinone (Primacor)
    • Mechanism of action: block enzyme phosphodiesterase in cardiac and smooth muscle, increasing myocardial contraction force and cardiac output
    • Primary use: as short-term therapy for heart failure
    • Adverse effects: hypokalemia, hypotension, ventricular dysrhythmias

    Mechanisms of Action of Drugs Used for Heart Failure

    • (Diagram)*
    • Shows how various drugs (adrenergic blockers, vasodilators, phosphodiesterase inhibitors, ACE inhibitors, angiotensin receptor blockers, cardiac glycosides, and diuretics) influence various systems in the body to improve heart function in heart failure.

    Patient Teaching (1 of 5)

    • Therapeutic response time: weeks or months
    • Sodium and potassium restrictions
    • Don't use with other medications, herbals, or vitamins

    Patient Teaching (2 of 5)

    • Monitor sodium intake
    • Report weight loss
    • Report fatigue and muscle cramps
    • Change position slowly

    Patient Teaching (3 of 5)

    • Monitor blood pressure/pulse
    • Report pulse below 50
    • Report signs/symptoms of worsening heart failure
    • Do not stop taking abruptly

    Patient Teaching (4 of 5)

    • Monitor therapeutic levels with laboratory tests
    • Know signs/symptoms of toxicity
    • Monitor pulse rate
    • Report weight gain
    • Eat foods high in potassium

    Patient Teaching (5 of 5)

    • Report irregular or rapid heart rate
    • Report fever of 101 degrees F or higher or increase in chest pain
    • If given IV, report fever of 101 degrees F or higher or pain/swelling at infusion site

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    Lecture 5 Drugs For Heart Failure PDF

    Description

    Test your knowledge about heart failure, including its causes, symptoms, and types. Learn about the underlying pathophysiology and the diseases associated with heart failure. This quiz covers both left-sided and right-sided heart failure.

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