Congestive Cardiac Failure (CCF)

List the minimum combination of Framingham major and minor clinical criteria required to diagnose congestive heart failure.

2 major criteria, 1 major criterion paired with 2 minor criteria

A documented weight loss of greater than [...] kg across 5 days strictly in response to therapeutic diuretic initiation satisfies a Framingham criterion.

4.5

For which 2 specific heart failure patient profiles is measuring plasma thyroxine concentrations considered a mandatory baseline requirement?

age older than 65 years, patients with concomitant atrial fibrillation

What is the first-line definitive diagnostic modality to quantify ejection fraction, and what is the gold-standard modality for multi-chamber volumes?

transthoracic echocardiography, cardiac MRI

Match NYHA functional classification Class III and Class IV to their respective 1-year statistical survival rates.

Class III is 55 to 65 percent, Class IV is 5 to 15 percent

List the 4 distinct chest X-ray findings that confirm advanced pulmonary congestion secondary to elevated left atrial pressures.

upper lobe diversion, Kerley B lines, peribronchial cuffing, pleural effusions

Structural cardiomegaly from long-standing ventricular pressure or volume overload is confirmed on a chest X-ray when the cardiothoracic ratio is greater than [...].

50 percent

Contrast heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) based on their primary functional defects.

HFrEF is impaired myocardial pump contractility, HFpEF is impaired ventricular compliance and diastolic relaxation

Pressure overload states induce concentric hypertrophy with sarcomeres synthesized [...], whereas volume overload states induce eccentric hypertrophy with sarcomeres synthesized [...].

in parallel, in series

According to the Law of Laplace, myocardial wall tension is directly proportional to intra-chamber pressure and [...] and inversely proportional to [...].

chamber radius, two times wall thickness

Myocardial relaxation or lusitropy is an ATP-dependent process requiring cAMP to activate the sarcoplasmic reticulum calcium ATPase pump by inhibiting which specific protein?

phospholamban

What cellular change happens to cardiac beta-1 adrenergic receptors during prolonged, chronic sympathetic overactivation in heart failure?

desensitization and down-regulation

In chronic systolic heart failure, the Frank-Starling relationship curve flattens and shifts to the [...], meaning fluid retention causes congestion without increasing [...].

right, stroke volume

Atrial natriuretic peptide (ANP) is released primarily from the walls of the [...] and brain natriuretic peptide (BNP) from the [...] in response to elevated chamber stretch.

atria, ventricles

Why must chronic beta-blocker therapy be initiated at ultra-low doses and withheld during acute decompensated heart failure phases?

introducing them abruptly during an active congested or decompensated phase will precipitate fatal pump failure

What long-term cellular adaptation do beta-blockers promote on cardiac tissue to reverse chronic sympathetic-induced myocardial dysfunction?

up-regulation of beta-adrenergic receptors

To overcome diuretic resistance caused by low cardiac output and compensatory distal nephron hypertrophy, what drug class combination is utilized?

loop diuretics combined with thiazide diuretics

Digoxin exerts its positive inotropic effect by directly inhibiting the sarcolemmal [...] pump, which accumulates intracellular sodium and secondarily reverses the [...] exchanger.

Na+/K+-ATPase, sodium-calcium

What specific electrolyte derangement dramatically worsens digitalis toxicity, and what classic visual disturbance characterizes this toxic state?

hypokalaemia, yellow-green halos

List the 3 dose-dependent receptor activation thresholds of a Dopamine infusion and their corresponding primary physiological actions.

1 to 5 mcg/kg/min causes renal vasodilation, 5 to 10 mcg/kg/min drives positive inotropy, greater than 10 mcg/kg/min causes intense alpha-1 vasoconstriction

What pharmacological phenomenon causes Dobutamine to lose therapeutic efficacy during prolonged continuous infusion, and what receptor type drives it?

tachyphylaxis due to beta-1 adrenergic receptor down-regulation

Name the drug class of milrinone and amrinone, and explain how they concurrently increase cardiac contractility while reducing left ventricular afterload.

phosphodiesterase-3 inhibitors, they elevate intracellular cAMP which increases contractility in myocytes while causing smooth muscle vasodilation in blood vessels

SGLT2 inhibitors like dapagliflozin promote volume reduction and protect the heart by targeting the proximal convoluted tubule to induce [...] and [...].

glucosuria, natriuresis

Mineralocorticoid receptor antagonists like spironolactone reduce myocardial fibrosis, but carry a high risk of causing which metabolic lab abnormality and which systemic side effect?

hyperkalaemia, painful gynecomastia

Ivabradine safely lowers a heart failure patient's heart rate without affecting contractility by selectively inhibiting the pacemaker [...] current directly in the [...].

If funny, sinoatrial node

Worsening renal function in congestive heart failure driven by a combination of low arterial perfusion pressure and chronic venous congestion is called [...].

cardiorenal syndrome

Pressure applied by an examiner on the liver that elicits a prominent, obvious triple-wave venous pulse in the neck confirms a positive [...].

hepato-jugular reflux

List 4 systemic high-output states that can precipitate heart failure by drastically expanding venous return to a structurally normal heart.

severe anemia, thyrotoxicosis, pregnancy, active infection