Según el documento, ¿cómo definen la insuficiencia cardiaca las guías ACCF/AHA?

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16:null 1a:[["$","title","0",{"children":"ICC - Krog | Krog"}],["$","meta","1",{"name":"description","content":"yano"}],["$","meta","2",{"name":"application-name","content":"Krog"}],["$","link","3",{"rel":"manifest","href":"/manifest.json","crossOrigin":"$undefined"}],["$","meta","4",{"name":"mobile-web-app-capable","content":"yes"}],["$","meta","5",{"name":"apple-mobile-web-app-title","content":"Krog"}],["$","meta","6",{"name":"apple-mobile-web-app-status-bar-style","content":"black-translucent"}],["$","meta","7",{"property":"og:title","content":"ICC - 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La IC se define como un síndrome clínico complejo resultado de una alteración estructural o funcional del llenado ventricular o de la expulsión de sangre. ¿Cuáles son síntomas clínicos cardinales mencionados en el documento? Se mencionan disnea y fatiga como síntomas clínicos cardinales. ¿Cuáles son signos de insuficiencia cardiaca mencionados explícitamente? El documento menciona edema y estertores como signos de insuficiencia cardiaca. Según el documento, aproximadamente ¿cuál es la mortalidad a 5 años de la insuficiencia cardiaca? Se indica una mortalidad a 5 años de aproximadamente 50% de los pacientes. ¿Qué porcentaje aproximado de los pacientes que desarrollan IC tienen una fracción de eyección normal o conservada? Casi 50% de los pacientes que desarrollan IC tienen FE normal o conservada (>50%). La IC con reducción de la fracción de eyección era conocida históricamente como: La IC con reducción de la fracción de eyección era conocida como insuficiencia sistólica. La IC con conservación de la fracción de eyección era conocida históricamente como: La IC con conservación de la fracción de eyección era conocida como insuficiencia diastólica. Según el documento, ¿cuál es la causa más común de IC en Estados Unidos? La causa más común de IC en USA se señala como enfermedad arterial coronaria. ¿Cuál de los siguientes procesos forma parte de los mecanismos involucrados en la insuficiencia sistólica temprana? Entre los procesos involucrados se menciona el reflejo barorreceptor. Según los ensayos clínicos mencionados, ¿qué resulta más valioso en el tratamiento a largo plazo de la IC? Los ensayos clínicos demostraron mayor valor de la terapia dirigida a objetivos no cardiacos frente a los agentes inotrópicos positivos tradicionales. Durante la contracción cardiaca, ¿con qué sistema interactúa el calcio activador para liberar la interacción actina-miosina? El calcio activador interactúa con el sistema actina-troponina-tropomiosina. ¿De dónde se libera el calcio activador mencionado en el documento? El calcio activador se libera del retículo sarcoplásmico. ¿Cuál es el sitio de acción de los digitálicos como la digoxina? La bomba Na/K ATPasa es señalada como sitio de acción de los digitálicos como la digoxina. ¿Qué función se atribuye al NCX? El NCX es el translocador de sodio-calcio. ¿Qué es el Ca-L según el documento? El Ca-L es el canal de calcio tipo L regulado por voltaje. ¿Qué función tiene SERCA? SERCA bombea calcio al interior del retículo sarcoplásmico. ¿Qué es el RyR? RyR es el receptor de rianodina, un canal de calcio activado por calcio. En la IC por disfunción sistólica, ¿qué ocurre con el gasto cardiaco y la fracción de eyección? La disfunción sistólica presenta gasto cardiaco reducido y fracción de eyección significativamente reducida. La disfunción diastólica ocurre a menudo como resultado de: La disfunción diastólica ocurre a menudo como resultado de hipertrofia y rigidez del miocardio. En la disfunción diastólica, la fracción de eyección puede ser: En la disfunción diastólica, aunque se reduce el gasto cardiaco, la fracción de eyección puede ser normal. Según el documento, la insuficiencia cardiaca por disfunción diastólica generalmente: El documento señala que la IC por disfunción diastólica por lo general no responde bien a los fármacos inotrópicos. ¿Cuáles son los dos mecanismos principales de la compensación neurohumoral extrínseca? La compensación neurohumoral implica el sistema nervioso simpático y la respuesta hormonal R-A-A. En pacientes con ICC, ¿qué ocurre con la sensibilidad del reflejo barorreceptor? El reflejo barorreceptor presenta menor sensibilidad a la presión arterial. El incremento del tono simpático produce: El incremento del tono simpático causa taquicardia, aumento de la contractilidad cardiaca y del tono vascular. Según el documento, la vasoconstricción aumenta: La vasoconstricción aumenta la poscarga. ¿Cuáles son las neurohormonas mencionadas como producidas tras la disminución del gasto cardiaco? La disminución del gasto cardiaco activa la producción de norepinefrina, angiotensina II y endotelina. El aumento de la secreción de angiotensina II conduce a una mayor liberación de: El aumento de angiotensina II conduce a una mayor liberación de aldosterona. El aumento de aldosterona produce, según el documento: La aldosterona aumenta la reabsorción de sodio y agua. ¿Cuál es descrito como el mecanismo compensatorio más obvio? La hipertrofia miocárdica se describe como el mecanismo compensatorio más obvio. ¿Qué término se aplica a la dilatación y otros cambios estructurales lentos que ocurren en el miocardio estresado? Remodelación es el término aplicado a la dilatación y otros cambios estructurales lentos del miocardio estresado. ¿Cuál de los siguientes es uno de los cambios descritos en la remodelación de la IC con fracción de eyección reducida? Entre los cambios de la remodelación se incluye la hipertrofia de los miocitos. ¿Cuál de los siguientes estudios aparece entre los métodos diagnósticos mencionados? El diagnóstico incluye ecocardiograma transtorácico. ¿Cuáles son los biomarcadores mencionados para el diagnóstico? Los biomarcadores mencionados son BNP y ProBNP. ¿Cuál es el prototipo de los inotrópicos positivos originados del digitalis? El prototipo de los inotrópicos positivos es la digoxina. Los inotrópicos positivos: El documento indica que los inotrópicos positivos no son los primeros fármacos utilizados en IC. ¿Qué porcentaje de digoxina se absorbe por vía oral según el documento? La digoxina se absorbe en 65-85% por vía oral. ¿Cuánto de la dosis de digoxina se excreta sin cambios en los riñones? Dos tercios de la dosis de digoxina se excretan sin cambios por los riñones. ¿Cuál es la vida media de la digoxina mencionada? La vida media de la digoxina es de 36-40 horas. ¿Cuál es el efecto de los glucósidos cardiacos sobre la concentración de calcio libre? Los glucósidos cardiacos incrementan la contracción al aumentar la concentración de calcio libre. El aumento del calcio intracelular producido por los glucósidos cardiacos se relaciona con: El aumento del calcio se relaciona con el aumento del sodio intracelular por inhibición de la bomba Na/K ATPasa. ¿Qué efecto neto tienen las concentraciones terapéuticas de un glucósido cardiaco sobre la contractilidad? El resultado neto de concentraciones terapéuticas es un aumento característico de la contractilidad cardiaca. ¿Qué enzima inhibe la milrinona? Milrinona inhibe la isoenzima fosfodiesterasa 3. ¿Cuál es una característica de la disponibilidad de la milrinona? Milrinona está disponible únicamente por vía parenteral. La inhibición de la fosfodiesterasa por milrinona produce: La inhibición de fosfodiesterasa produce aumento del AMPc, contractilidad y vasodilatación. ¿Para qué situación se utiliza solamente la milrinona según el documento? Milrinona se utiliza solamente para IC aguda o exacerbación de IC crónica. ¿Cuál es la dosis de infusión de milrinona indicada? La dosis en infusión indicada es 0.5-0.75 mcg/kg/min. ¿Cuál es el agonista B1 selectivo más usado en pacientes con IC descompensada aguda? Dobutamina es el agonista B1 selectivo más usado en pacientes con IC descompensada aguda. ¿Qué efecto produce la dobutamina sobre el gasto cardiaco y la presión de llenado ventricular? Dobutamina aumenta el gasto cardiaco junto con disminución de la presión de llenado ventricular. ¿Cuál es la dosis de dobutamina indicada en el documento? La dosis indicada de dobutamina es 2-15 mcg/kg/min. ¿Cuál es uno de los efectos adversos mencionados de la dobutamina? Entre los efectos adversos mencionados están algunos casos de taquicardia. La dopamina estimula receptores: Dopamina es agonista de receptores dopaminérgicos D1-D5. ¿Qué efecto tiene la dopamina a dosis bajas, menores de 4 µg/kg/min? A dosis menores de 4 µg/kg/min produce vasodilatación arterial coronaria, renal y mesentérica. ¿Qué efecto tiene la dopamina a dosis intermedias de 4-10 µg/kg/min? A 4-10 µg/kg/min produce efectos inotrópicos y cronotrópicos positivos. ¿Qué efecto tiene la dopamina a dosis altas, mayores de 10 µg/kg/min? A dosis mayores de 10 µg/kg/min es vasopresora y aumenta la RVP. ¿Cuáles constituyen el tratamiento de primera línea para la insuficiencia cardiaca crónica? El tratamiento de primera línea de la IC crónica incluye diuréticos, IECA/ARAII, ISGLT2 y betabloqueadores. ¿Cuál es el diurético de elección para el manejo de IC mencionado? Furosemida es descrita como diurético de elección para el manejo de IC. ¿Cuál es el principal mecanismo hemodinámico de la furosemida en la ICC? En ICC, la furosemida reduce la presión venosa y la precarga ventricular. ¿Qué efecto adicional pueden producir espironolactona y eplerenona en pacientes con IC grave? Espironolactona y eplerenona generan beneficio adicional al disminuir morbilidad y mortalidad en IC grave. Los IECA y ARA II reducen la resistencia periférica y por tanto: IECA/ARA II reducen la resistencia periférica y, por tanto, disminuyen la poscarga. Además de disminuir la poscarga, los IECA/ARA II reducen: También reducen la retención de sal y agua, reduciendo así la precarga. ¿Qué efecto tienen los IECA/ARA II sobre la remodelación? IECA/ARA II reducen la remodelación a largo plazo del corazón y los vasos. ¿Por qué son eficaces los vasodilatadores en la IC aguda? Los vasodilatadores reducen la precarga por venodilatación, la poscarga o ambas. ¿Qué fármaco es descrito como una forma sintética del BNP? Nesiritida es descrita como una forma sintética del BNP. ¿Cuál es la vida media de la nesiritida? Nesiritida tiene una vida media corta de 18 minutos. ¿Cuál es un efecto adverso común de la nesiritida? El efecto adverso común señalado es hipotensión excesiva. Sacubitril es descrito como: Sacubitril es un profármaco que se metaboliza hacia un inhibidor de neprilisina activo. ¿Qué combinación está aprobada para su uso en IC con fracción de eyección reducida? La combinación valsartán-sacubitril está aprobada para IC con fracción de eyección reducida. ¿Cuáles son los péptidos relacionados mencionados junto a los inhibidores de neprilisina? Se mencionan ANP y urodilatina entre los péptidos relacionados. ¿Cuáles son los cuatro betabloqueadores mencionados cuyos estudios mostraron reducción de la mortalidad en pacientes con IC severa estable? Los estudios con bisoprolol, carvedilol, metoprolol y nebivolol mostraron reducción de mortalidad en IC severa estable. ¿Cuál de los siguientes efectos se menciona entre las acciones de los betabloqueadores? Entre los efectos de los betabloqueadores se menciona la disminución de la frecuencia cardiaca. ¿Qué hacen los ISGLT-2 según el documento? Los ISGLT-2 aumentan la excreción renal de sodio e inducen glucosuria. En pacientes con diabetes tipo 2, los ISGLT-2 reducen: Se indica que reducen las hospitalizaciones por IC en pacientes con diabetes tipo 2. En pacientes de alto riesgo, etapa A y B, el tratamiento debe enfocarse en el control de: En etapa A y B el tratamiento debe enfocarse en hipertensión, arritmias, hiperlipidemia y diabetes. En el manejo de IC crónica, ¿qué grupo se utiliza para la extracción de sodio? En el manejo de IC crónica, la extracción de sodio corresponde a los diuréticos. En el manejo de IC crónica, ¿qué grupo se utiliza para el manejo de las altas concentraciones de catecolaminas? El manejo de altas concentraciones de catecolaminas corresponde a betabloqueadores cardioselectivos. En el manejo de IC crónica, ¿qué grupo se indica para el manejo de arritmia y FA? El manejo de arritmia y FA se señala con digitálicos. Según el documento, la IC aguda ocurre en: El documento indica que la IC aguda ocurre en pacientes con IC crónica. ¿Cuál de las siguientes situaciones aparece como asociada a IC aguda? La IC aguda puede asociarse con ingesta excesiva de sal, entre otras situaciones mencionadas. ¿Cuál es una causa frecuente de IC aguda mencionada en el documento? Una causa frecuente de IC aguda señalada es el IAM. ¿Cuál de los siguientes corresponde a los fármacos de elección para IC aguda según el documento? 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ICC

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