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Heart Failure Pathophysiology and Treatments
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1
Question
What are the cardinal symptoms of heart failure listed in the slides?
Page 1
Answer
The cardinal symptoms of heart failure are dyspnea, fatigue, and fluid retention.
2
Question
How does the slide define heart failure in one sentence?
Page 1
Answer
Heart failure is defined as the heart being unable to pump sufficient blood to meet the needs of the body.
3
Question
According to the slides, what is the most common cause of heart failure?
Page 1
Answer
The most common cause of heart failure is coronary artery disease.
4
Question
What happens to cardiac output and systemic oxygenation in heart failure according to the diagram?
Page 2
Answer
Cardiac output decreases, leading to central and peripheral hypoxia and activation of compensatory systems such as RAAS and sympathetic activity.
5
Question
Which compensatory systems increase activity in response to reduced cardiac output on the slide?
Page 2
Answer
The compensatory systems that increase activity are the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system.
6
Question
What structural cardiac change is shown as a consequence of increased sympathetic activity in the slide diagram?
Page 2
Answer
Myocardial hypertrophy is shown as a consequence of increased sympathetic activity.
7
Question
What is the shared hemodynamic result of both systolic and diastolic dysfunction as presented on the slide?
Page 3
Answer
Both systolic and diastolic dysfunction lead to a decrease in cardiac output and reduced stroke volume.
8
Question
How does systolic dysfunction affect ejection fraction according to the slides?
Page 4
Answer
Systolic dysfunction results in a reduced ejection fraction (EF) of the heart.
9
Question
What are the two pathological mechanisms listed as causes of systolic dysfunction?
Page 4
Answer
Systolic dysfunction results from reduced mechanical pumping action (contractility) and loss of contracting fibers following myocardial infarction.
10
Question
How does diastolic dysfunction affect ventricular filling as described on the slide?
Page 4
Answer
Diastolic dysfunction causes stiffening and loss of adequate relaxation, increasing resistance to filling of the ventricles.
11
Question
What is said about ejection fraction in diastolic dysfunction on the slide?
Page 4
Answer
In diastolic dysfunction the ejection fraction (EF) may be reduced or normal.
12
Question
What diagnostic tool is described by the slide stating it uses high frequency sound waves?
Page 5
Answer
An echocardiogram is described as using high frequency sound waves to create an image of the heart.
13
Question
What is the normal range for left ventricular ejection fraction given on the slide?
Page 6
Answer
The normal ejection fraction range given is 60–72%.
14
Question
What are the three therapeutic approaches in heart failure listed on the slide?
Page 8
Answer
The therapeutic approaches are reduction of afterload, reduction of preload, and increase of contractility.
15
Question
Which drug classes are listed as reducing both preload and afterload on the slide?
Page 9
Answer
The slide lists ACE inhibitors and AT1-blockers as drugs that reduce pre- and afterload.
16
Question
Which diuretic classes are listed on the slide as drugs that decrease preload?
Page 9
Answer
Thiazide and loop diuretics are listed as drugs that decrease preload.
17
Question
Which drug class examples are provided on the slide under beta-blockers used in heart failure?
Page 9
Answer
Beta-blocker examples provided are bisoprolol, metoprolol, and nebivolol.
18
Question
Which inotropic drug classes are listed on the slide for heart failure treatment?
Page 9
Answer
Inotropic drug classes listed include cardiac glycosides, PDE inhibitors, and β1 agonists.
19
Question
According to the slides, what triggers renin release by juxtaglomerular cells in the kidney?
Page 10
Answer
Renin release is triggered by decreased renal perfusion pressure and by sympathetic stimulation with activation of β receptors.
20
Question
Which systems do ACE inhibitors affect according to the slide?
Page 11
Answer
ACE inhibitors affect the renal RAAS, vascular RAAS, and the kallikrein-kinin system.
21
Question
How do ACE inhibitors reduce cardiac preload according to the slides?
Page 11
Answer
ACE inhibitors reduce preload by lowering aldosterone, which decreases venous tone and preload.
22
Question
What two pathways produce vasodilation with ACE inhibitor therapy as stated on the slide?
Page 11
Answer
Vasodilation occurs due to decreased angiotensin II levels and increased bradykinin levels.
23
Question
Do ACE inhibitors normally affect cardiac contractility and cardiac output according to the slide?
Page 11
Answer
ACE inhibitors do not affect cardiac contractility, and cardiac output is normally increased.
24
Question
What indications for ACE inhibitors in heart failure are listed on the slide?
Page 12
Answer
Indications include heart failure associated with systolic dysfunction with or without water retention, in both asymptomatic and symptomatic HF, and to improve renal function and provide cardioprotective effects.
25
Question
What long-term cardiac structural effect do drugs affecting the RAAS have according to the slide?
Page 12
Answer
Drugs affecting the RAAS reduce remodeling of the heart and vessels.
26
Question
Name three ACE inhibitor drugs listed on the slide.
Page 12
Answer
Enalapril, trandolapril, and lisinopril are three ACE inhibitor drugs listed.
27
Question
What vascular structural change was observed in essential hypertensive patients compared to normotensive controls in the slide study?
Page 13
Answer
Vessels from essential hypertensive patients showed eutrophic remodeling, a rearrangement of the same number and size of smooth muscle cells around a smaller lumen.
28
Question
According to the slide, which ACE inhibitors are exceptions to being prodrugs?
Page 14
Answer
Captopril and lisinopril are exceptions to ACE inhibitors being prodrugs.
29
Question
Which ACE inhibitor does the slide state is not primarily renally eliminated?
Page 14
Answer
Fosinopril is stated as the ACE inhibitor for which renal elimination is less important.
30
Question
Which ACE inhibitor on the slide has an indicated half-life of 25 hours?
Page 14
Answer
Perindopril is indicated on the slide as having a half-life of 25 hours.