Cardiac Clinical Medicine Part 3: Heart Failure

Question 1

What are the cardinal clinical symptoms of heart failure?

What are the signs?

Answer 1

1) Dyspnea and fatigue

2) Edema and rales

Question 2

HF with preserved ejection fraction (“HFpEF”) is defined as?

HF with reduced ejection fraction (“HFrEF”) is defined as?

Which makes up 50% of all HF cases?

Answer 2

1) LVEF ≥50%
2) LVEF <40%
3) HFrEF

Question 3

What happens to the wall of the myocardium with HFpEF?

What happens to it with HFrEF?

Answer 3

1) Thickened

2) Thins and weakens

Question 4

What is the most common cause of HFrEF?

Answer 4

CAD

Question 5

What are some risk factors for HFrEF?

Answer 5

1) Male
2) LVH
3) Bundle branch block
4) Previous MI
5) Smoking

Question 6

What are some risk factors for HFpEF?

Answer 6

1) Older age
2) Female
3) HTN
4) Afib

Question 7

When is the diagnosis of HF most challening?

Answer 7

In its early stages

Question 8

What are some HF symptoms of congestion?

Answer 8

1) Dyspnea
2) Paroxysmal nocturnal dyspnea
3) Nocturnal cough
4) Weight fluctuations

Question 9

What are some HF symptoms of hypoperfusion?

Answer 9

1) Exercise intolerance
2) Fatigue
3) Cold intolerance

Question 10

What is the cardiac biomarker for HF?

Answer 10

BNP

Question 11

What imaging is recommended with suspected HF?

Answer 11

Echocardiography (2D TTE)

Question 12

What is class A of ACCF and AHA staging?

Class B?

Class C?

Class D?

Answer 12

A) High risk of HF but without structural heart disease
B) Structural heart disease but without symptoms of HF
C) Structural heart disease with symptoms of HF
D) Refractory HF requiring specialized intervention

Question 13

Which ACCF and AHA class are majority of the patients in?

Answer 13

Class B

Question 14

The NYHA functional classification (I-IV stages) is based on?

Answer 14

Ability to perform physical activity and if it causes symptoms of heart failure

Question 15

What helps improve the symptoms of HFrEF?

Answer 15

Diuretics

Question 16

Improving quality and duration of life due to HFrEF is based on?

What is the initial therapy to accomplish this?

If they are still symptomatic what should be done?

Answer 16

1) Preventing remodeling
2) ACEi and Beta-blockers
3) Add Mineralocorticoid antagonist

Question 17

In the absence of HTN, evidence does not support treating HFpEF with any medication except?

What is important in the long-treatment of HFpEF?

Answer 17

1) Diuretics

2) Treat comorbidities

Question 18

Cor Pulmonale develops in response to?

What is responsible for about half of these cases?

Answer 18

1) Chronic pulmonary HTN

2) COPD and chronic bronchitis

Question 19

What does Cor Pulmonale lead to?

Answer 19

Increased RV afterload sufficient to alter RV structure and function

Question 20

What symptoms are associated with cor pulmonale?

Answer 20

1) LE swelling

2) Increased abdominal girth from ascites

Question 21

What sign is seen in the neck with cor pulmonale?

In the heart?

In the lungs?

Answer 21

1) Elevated JVP
2) Tricuspid murmur and S3 gallop
3) Wheezing/rales

Question 22

What will ekg show with cor pulmonale?

Answer 22

Right axis deviation and RV hypertrophy

Question 23

What imaging may be used for diagnosing cor pulmonale when 2D TTE is not clear?

Answer 23

MRI and cardiac catheterization