Cardiology Review: Heart Failure, Vascular Diseases, and Related Conditions

A comprehensive set of Q&A style flashcards covering preload/afterload, heart failure types and treatments, diagnostic workups, vascular diseases, and related syndromes as presented in the lecture notes.

What is preload?

The amount or volume of blood returning to the heart (venous return).

What increases preload?

Increased blood volume from fluids or high sodium intake and regurgitation of heart valves.

What is afterload?

The resistance the heart has to pump against; increased by high blood pressure and peripheral vasoconstriction.

What is stroke volume?

The volume of blood ejected in a single contraction (in milliliters).

How is cardiac output calculated?

Cardiac output = stroke volume × heart rate.

What is the normal range for ejection fraction (EF)?

50–70%.,

What does an EF < 40% indicate?

Heart failure with reduced ejection fraction (HFrEF, systolic dysfunction).

What is HFpEF?

Heart failure with preserved ejection fraction (diastolic dysfunction).

Name the four guideline-indicated medications for HFrEF.

ARNI (valsartan + sacubitril), beta-blocker (carvedilol, metoprolol succinate, bisoprolol), aldosterone receptor antagonist (spironolactone, eplerenone), and SGLT2 inhibitor (dapagliflozin or empagliflozin).

How does sacubitril work in ARNI?

Sacubitril inhibits neprilysin, increasing natriuretic peptides (e.g., BNP) and promoting diuresis and vasodilation.

Why switch from an ACE/ARB to an ARNI?

ARNI provides better outcomes; stop the ACE/ARB for 36 hours before switching to avoid angioedema and hypotension.

What is a key adverse effect of ARNI therapy?

Hypotension; risk of angioedema.

What is the role of beta blockers in HFrEF?

Reduce arrhythmia risk, lower heart rate, and help improve EF; uptitrate to the highest tolerated dose.

What are mineralocorticoid receptor antagonists used for in HF?

Block aldosterone effects to reduce preload/afterload; monitor potassium; spironolactone can cause gynecomastia.

What is the role of SGLT2 inhibitors in HFrEF?

Reduce hospitalizations and mortality; avoid in type 1 diabetes due to DKA risk; increases risk of UTIs and genital infections.

What is the purpose of loop diuretics in heart failure?

Diuresis to reduce volume; monitor electrolytes and blood pressure; risk of hypotension and ototoxicity with rapid use.

When might advanced therapies be considered for HFrEF?

If medications fail to improve EF or symptoms; options include ICD, LVAD, and heart transplant.

How is HFpEF generally managed?

Diuretics for symptoms; some use MR antagonists or ARNI; focus on blood pressure control and underlying conditions.

What is restrictive cardiomyopathy and its typical cause?

Disease with stiff ventricles, often due to infiltration (amyloidosis, sarcoidosis, hemochromatosis); EF may be preserved; poor prognosis.

What are key features and treatments for hypertrophic cardiomyopathy (HOCM)?

Thickened heart walls; may be obstructive or non-obstructive; risk of ventricular arrhythmias and SCD; beta blockers, myectomy, alcohol septal ablation, consider ICD in high-risk patients.

What is Takotsubo (stress) cardiomyopathy?

Apical ballooning due to catecholamine surge; often triggered by emotional stress; mural thrombus risk; anticoagulation if thrombus; EF typically recovers.

What is the DVT triad?

Stasis of blood flow, hypercoagulable states, and vascular damage.

What is the initial management for a suspected DVT?

Anticoagulation (heparin, enoxaparin, or DOACs); duration typically 3–6 months depending on provoking factors; consider hematology workup for thrombophilia; target INR 2–3 if on warfarin.

When is an IVC filter used for DVT?

When anticoagulation is contraindicated or cannot be safely given.

How is peripheral arterial disease diagnosed and staged?

Ankle-brachial index (ABI) < 0.9 indicates PAD; Doppler imaging to locate stenosis; CT angiography for limb-threatening ischemia.

What are common PAD treatments and medications?

Revascularization (stents, bypass), risk factor control, antiplatelets (aspirin, possibly clopidogrel), rivaroxaban for PAD, statins, cilostazol for claudication, and structured exercise.

What are typical signs of Raynaud phenomenon and its treatment?

Vasospasm causing color change (white, blue, red) in fingers; treated with calcium channel blockers (amlodipine, nifedipine) and avoiding cold exposure.

What is Buerger disease and its management?

Thromboangiitis obliterans; strongly linked to smoking; treatment centers on complete tobacco cessation; may lead to gangrene.

What are the two primary presentations of ischemic bowel and their management?

Acute ischemia: pain out of proportion, CT diagnosis, surgical resection; Chronic mesenteric ischemia: postprandial pain and weight loss, treated with angioplasty or stenting.

What are the aneurysm screening and treatment thresholds for abdominal aortic aneurysm (AAA)?

Screen male smokers 65–75 with ultrasound; repair typically at ≥5.5 cm (5.0 cm in Marfan); beta blockers slow growth; stent graft repair when indicated.

How are thoracic aortic aneurysms managed and what dissection types exist?

Beta blockers to slow growth; CT for sizing; Type A dissection (ascending/aortic arch) requires immediate surgery; Type B (descend downward) often managed medically with IV beta blockers unless intervention indicated; Marfan/Ehlers-Danlos increase risk.

What is temporal arteritis and how is it treated?

Giant cell arteritis presenting with unilateral scalp pain and possible jaw pain; elevated ESR; temporal artery biopsy; treatment with prednisone plus aspirin and sometimes methotrexate; important to prevent vision loss.

What are common causes of syncope and how is it evaluated?

Vasovagal, situational, orthostatic (dysautonomia), and cardiogenic; evaluate with orthostatic BP, ECG, troponin, CBC, electrolytes; tilt-table testing can be used for outpatient assessment.