Cardio Exam 5 (Anderson and Hoehns intro)

T/F: stopping the “vicious cycle” of heart failure prevents it from worsening

True

Vasodilators

decrease venous volume/pressure and thus decrease afterload

Diuretics

relieve congestion and edema

Positive isotropic drugs

increase cardiac output

ACE inhibitors

inhibit RAAS and stop cardiac remodeling

Beta blockers

stop cardiac remodeling and increase CO

T/F: because beta blockers increase heart rate, they lead to a decrease in O2 demand

False, they DECREASE heart rate which leads to a decrease in O2 demand

T/F: Beta blockers allow for longer filling time which increases the amount of blood available to be squeezed out with each contraction which increases cardiac output despite slower rate of contractions and decrease in inotropy

True

Which drug decreases heart rate without changing contractility?

Ivabradine

Cardiac Glycoside MOA

Positive inotropy

Which drug class has the following responses?

• decrease in sympathetic tone

• increase in urine production

• decrease in renin release

Cardiac glycosides

Digoxin class

Cardiac glycoside

Digoxin MOA

Directly inhibits Na/K ATPase, which indirectly inhibits Ca/Na exchanger, leading to an INCREASE in intracellular calcium

Increase in intracellular calcium in heart myocytes leads to…

stronger contraction

T/F: cardiac glycosides depolarize all heart cells, decreasing vagal/parasympathetic tone, and decreasing automaticity of the SA and AV nodes

False, they INCREASE valgal tone which decreases automaticity

T/F: despite having a narrow therapeutic window, because the half life of digoxin is short, plasma levels do not have to be monitored

False, the half life is LONG, so monitoring in necessary

The following are side effects of what medication?

• Delayed after depolarizations due to increased intracellular calcium

• hypokalemia induced arrhythmias

• Yellow-green visual halos

• Disorientation/hallucinations

• Agitation

• Convulsion

Digoxin

T/F: HypERkalemia increases the effect of digoxin

False, it DECREASES digoxin effect and hypOkalemia increases digoxin effect because K+ and digoxin inhibit each other’s binding to NA/K ATPase,

T/F: Magnesium opposes hypercalcemia and DECREASES the risk of arrhymias

True

The following drugs interact with which drug?

• Diuretics (due to decrease in potassium and magnesium)

• Verapamil (slow GI motility)

• Loperamide (slow GI motility)

• Antacids

Digoxin

Mavacamten indication

Obstructive hypERtrophy (thickening of heart muscles)

Mavacamten MOA

Inhibits myosin from crossbridging with actin in the sarcomere to improve left ventricle outflow and reduce excessive contractility

Recombinant BNP MOA

Increases cGMP to cause vasodilation and increases diuresis

BNPs have what effect on the SNS and RAAS?

Decrease activity of both

T/F: Recombinant BNP should only be used in patients with chronic heart failure

False, it should only be used in ACUTE heart failure

Neprilysin MOA

An endogenous enzyme that digests and inactivates BNP

Sacubitril MOA

Inhibits neprilysin enzyme to increase BNP levels

Valsartan MOA

Angiotensin two receptor one (AT1) inhibitor

T/F: BNP both a diagnostic marker and treatment for heart failure

True

In heart failure, stroke volume ____ as filling pressure increases

does NOT increase

In healthy hearts, stroke volume ____ as filling pressure increases

increases

Increasing preload (Na retention) leads to what detrimental effect?

Increased congestion/edema and increased myocardial O2 demand

Vasocontriction leads to what detrimental effect?

Increased afterload → decreased stroke volume (vicious cycle) and increased myocardial O2 demand

Tachycardia and increased contractility lead to what detrimental effect?

Decreased filling time, increased arrhythmia risk, increased myocardial O2 demand

Ventricular hypERtrophy/remodeling lead to what detrimental effect?

Systolic/diastolic dysfunction/arrhythmias, increased risk of ischemia/cell death

Which compensatory response is the only one that DECREASES myocardial O2 demand?

Ventricular hypERtrophy/remodeling

T/F: heart failure definition: symptoms/signs are caused by a structural or functional cardiac abnormality with both of the following

• Elevated BNP levels

• Objective evidence of pulmonary or systemic congestion

False, only needs to have ONE

LVEF less than or equal to 40%

HFrEF

Previous LVEF less than or equal to 40%, now greater than 40%

HFimpEP

LVEF 41%-49%

HRmrEF

LVEF greater than or equal to 50%

HFpEF

T/F: an S3 rhythm can appear in patients with chronic HF

True

T/F: chest radiographs and BNP levels are the only diagnostic tests for heart failure

False, echocardiograms can also be diagnostic

Patients have conditions including diabetes, hypertension, ASCVD etc but are without symptoms/structural disease/biomarkers

Stage A (at risk)

Have never had symptoms of HF, but have evidence of structural heart disease or increased BNPs or increased filling pressures

Stage B (pre heart failure)

Structural heart disease with current or previous symptoms of HF

Stage C (sympotmatic heart failure)

Marked symptoms that interfere with daily life despite optimized GDMT

Stage D (advanced)

No limitations of physical activity, doesn’t cause symptoms

Class 1

Slight limitations of physical activity, but comfortable at rest. Ordinary physical activity causes symptoms

Class 2

Marked limitation of physical activity, but comfortable at rest. Less than ordinary physical activity causes symptoms

Class 3

Unable to carry out any physical activity without symptoms OR symptoms occur even at rest

Class 4