Preload is the volume of blood filling the ventricles before contraction, and diuretics lower it by removing excess fluid.
Missing Word
Preload
Preload is the volume returning to and filling the ventricles at the end of diastole. Diuretics and venous dilators reduce it, which eases congestion and the heart's workload.
Category: Heart Failure Basics
Question 2
BNP released from overstretched ventricles promotes vasodilation and natriuresis, the loss of sodium in the urine.
Missing Word
natriuresis
Natriuresis is the excretion of sodium by the kidneys, and water follows the sodium out. BNP causes it as a natural defense against fluid overload, and sacubitril works by keeping BNP active longer.
Category: Heart Failure Basics
Question 3
Swelling of the face, lips, tongue and throat that can block the airway is angioedema, a rare but dangerous reaction to ACE inhibitors.
Missing Word
angioedema
Angioedema is rapid swelling of deep skin and mucous membranes. It is linked to bradykinin buildup with ACE inhibitors, requires stopping the drug and is an emergency when the airway is involved.
Category: RAAS Drugs
Question 4
The mineralocorticoid receptor antagonist eplerenone is more selective than spironolactone, so it is less likely to cause breast enlargement.
Missing Word
eplerenone
Eplerenone blocks the mineralocorticoid receptor with little effect on androgen and progesterone receptors. Spironolactone acts on those hormone receptors too, which is why it more often causes gynecomastia and breast tenderness.
Category: RAAS Drugs
Question 5
Afterload is the resistance the left ventricle must pump against, and drugs that dilate arteries lower it.
Missing Word
Afterload
Afterload is the pressure the ventricle must overcome to eject blood into the aorta. Lowering it with arterial vasodilators such as hydralazine or with RAAS drugs reduces the work of a failing heart.
Category: Heart Failure Basics
Question 6
Sacubitril is the neprilysin inhibitor combined with valsartan in the only ARNI drug.
Missing Word
Sacubitril
Sacubitril blocks neprilysin, the enzyme that breaks down natriuretic peptides. Paired with the ARB valsartan, it forms the angiotensin receptor-neprilysin inhibitor used in heart failure.
Category: RAAS Drugs
Question 7
Orthopnea, difficulty breathing while lying flat, leads many patients with heart failure to sleep propped up on pillows.
Missing Word
Orthopnea
Orthopnea is shortness of breath that appears when a person lies flat, because more blood returns to the heart and backs up into the lungs. Sitting up or using extra pillows eases it, and worsening orthopnea is a sign that heart failure is getting worse.
Category: Heart Failure Basics
Question 8
Among the beta blockers proven to lower mortality in HFrEF, carvedilol is the one that also blocks alpha-1 receptors.
Missing Word
carvedilol
Carvedilol blocks beta-1, beta-2 and alpha-1 receptors, so it lowers heart rate and also dilates blood vessels. Metoprolol succinate and bisoprolol are the cardioselective heart failure beta blockers.
Category: Beta Blockers
Question 9
By slowing the heart rate, beta blockers lengthen diastole, the relaxation phase when the ventricles fill and the coronary arteries are perfused.
Missing Word
diastole
Diastole is the part of the cardiac cycle when the heart muscle relaxes. A longer diastole improves ventricular filling and coronary blood flow, one reason heart rate control helps in heart failure.
Category: Beta Blockers
Question 10
SGLT2 inhibitors act in the proximal tubule, the segment of the nephron where nearly all filtered glucose is normally reabsorbed.
Missing Word
proximal
The proximal tubule is the first segment after the glomerulus and reclaims nearly all filtered glucose through sodium-glucose cotransporters. Blocking SGLT2 there sends sodium and glucose into the urine, and water follows, which lowers preload.
Category: SGLT2 Inhibitors
Question 11
Digoxin is cleared mainly by the kidneys, so toxicity becomes more likely when an older adult's clearance declines.
Missing Word
kidneys
Most digoxin leaves the body unchanged in the urine, so declining kidney function lets it build up. The nurse reviews renal function and watches for toxicity signs such as nausea, visual changes and a slow or irregular pulse.
Category: Adjunct Drugs
Question 12
Furosemide is contraindicated in anuria, a condition in which no urine is produced.
Missing Word
anuria
Anuria means essentially no urine output. A diuretic cannot work when the kidneys make no urine, and it may worsen kidney injury, so the drug is withheld.
Category: Diuretics
Question 13
Severe bradycardia, an abnormally slow heart rate, is a contraindication to starting metoprolol succinate.
Missing Word
bradycardia
Bradycardia is a heart rate slower than normal. Beta blockers slow the sinus rate and AV conduction further, so a patient who already has a severely slow rate could become unstable.
Category: Beta Blockers
Question 14
Ivabradine lowers the heart rate by blocking the funny current in the sinus node and is used in stable HFrEF when the resting rate stays high.
Missing Word
Ivabradine
Ivabradine blocks HCN channels that carry the pacemaker funny current. It slows the sinus rate without weakening contraction and reduces hospitalization for worsening heart failure.
Category: Adjunct Drugs
Question 15
Hydralazine is the direct arteriolar vasodilator combined with isosorbide dinitrate in a fixed-dose heart failure tablet.
Missing Word
Hydralazine
Hydralazine relaxes arteriolar smooth muscle to lower afterload, while the nitrate dilates veins to lower preload. The combination reduces mortality in self-identified Black patients with HFrEF.
Category: Adjunct Drugs