31- SOB

Question 1

Interventions to Slow the Progression of Coronary Artery Disease

Answer 1

BP control- ACEI + thiazide (synergistic)
aspirin
moderate statin
beta blocker, even if they dont have HTN

Question 2

Physical Exam Findings for Suspected Heart Failure

Answer 2

Crackles in the lung bases and dullness to percussion
JVD
PMI that is laterally displaced towards the axillary line
S3 from rapid ventricular filling or poor LV functioning
HSM, ascites
Lower extremity edema and check pulses
Sacral edema

Question 3

Differential for New Onset Congestive Heart Failure

Answer 3

MI
arrhythmia- afib or PSVT
Ischemic cardiomyopathy
Uncontrolled hypertension

Question 4

most common cause of CHF

Answer 4

Ischemic cardiomyopathy

Question 5

what should you do if your patient has new-onset CHF and you are unsure of the exact precipitating factors (particularly MI),

Answer 5

send to ER

Question 6

Radiographic Findings of Congestive Heart Failure

Answer 6

Cardiomegaly
Central vascular congestion and hilar fullness
Pleural effusions
Cephalization of pulmonary vasculature
Kerley B lines

Question 7

Kerley B lines

Answer 7

These are small linear densities 2-3 cm in length seen in the periphery of the lung fields on the PA view. They represent interstitial fluid in the lung tissue

Question 8

Diastolic Dysfunction

Answer 8

Diastolic heart failure occurs when signs and symptoms of heart failure are present, but left ventricular function is preserved (ejection fraction >45%).

more common in older women

Question 9

Diastolic Dysfunction cause

Answer 9

impaired LV filling and abnormal LV relaxation and is most commonly related to uncontrolled hypertension.

Question 10

can you have systolic HF without diastolic HF?

Answer 10

no!

Question 11

Pathophysiology of diastolic dysfunction

Answer 11

left ventricle develops an abnormality of filling and becomes stiffer and noncompliant as the disease progresses. Then there is increased pulmonary vessel pressure during exercise, increased filling pressure and, as left atrial pressure and size increase, congestion.

Question 12

what lab can help differentiate heart failure from non-cardiac conditions in patients with dyspnea

Answer 12

BNP- abnormal = CHF

Question 13

does positive stress test confirm CAD?

Answer 13

no, f/u with cardiac cath

Question 14

Management of Stage C Heart Failure

Answer 14

ACEI/ARBS
digoxin
loop diuretics
metoprolol succinate or carvedilol
Eplerenone

Question 15

Cardiac Test for Diagnosis of CAD in Patients with Intermediate Pre-Test Probability

Answer 15

Exercise treadmill testing (ETT)
Stress echo
Nuclear stress testing

Question 16

contra to exercise treadmill test

Answer 16

baseline EKG is not interpretable (which includes those with Wolff-Parkinson-White syndrome, a paced heart rhythm, a left bundle branch block, or more than 1 mm of ST depression at baseline).

Question 17

management of diastolic HF

Answer 17

minimize fluid overload with diuretics, control the blood pressure, slow down the heart rate (particularly in patients with atrial fibrillation), and manage comorbid CHD.

Question 18

cough presentation in CHF

Answer 18

worse at night, unable to lie flat, wakes from sleep