31 - 66 yo F with SOB

Question 1

what is the hepato-jugular reflux?

Answer 1

distension of jugular vein upon manual pressure on liver

Question 2

a very large S wave in V3 is strongly suggestive of ____

Answer 2

LVH

Question 3

diastolic HF has recently been renamed: ________

Answer 3

HF with preserved EF

Question 4

what is the pathophysiology of diastolic HF?

Answer 4

• LV develops an abnormality of filling and becomes stiffer and noncompliant
• increased pulmonary pressure during exercise , increased filling pressure
• as LA pressure and size increase, congestion occurs
• dyspnea and other clinical features begin to occur

Question 5

what lab value can be assessed to differentiate HF from non-cardiac conditions in a patient with dyspnea?

Answer 5

BNP

Question 6

what is the most common cause of CHF? second most?

Answer 6

• ischemic cardiomyopathy (CAD)

- diastolic dysfunction (due to uncontrolled HTN)

Question 7

kerley B lines represent: __________________

Answer 7

interstitial fluid in the lung tissue

Question 8

what is the E/A ratio? what is it indicative of?

Answer 8

• ratio of LV filling velocities

- marker of diastolic dysfunction

Question 9

all patient at intermediate risk of CAD (10-80%) should undergo _________________ testing as the initial diastolic test

Answer 9

exercise treadmill testing

Question 10

what is the initial diagnostic test for suspected CAD?

Answer 10

exercise treadmill testing

Question 11

what drug represents the mainstay of management of systolic HF?

Answer 11

ACE inhibitors