Cardiology_Heart Failure

Question 1

What is heart failure?

Answer 1

• The heart’s ability to pump is inadequate and unable to maintain the body’s circulatory needs.

Question 2

What are the two types of heart failure?

Answer 2

• Systolic Dysfunction and diastolic dysfunction.

Question 3

Describe Systolic Dysfunction

Answer 3

• dilated left ventricle with impaired ability to contract

Question 4

Describe diastolic dysfunction

Answer 4

left ventricle appears normal but has impaired ability to relax and fill

Question 5

what is a normal ejection fraction?

Answer 5

More than 55%

Question 6

Which has a normal EF, systolic or diastolic HF?

Answer 6

• Diastolic HF

Question 7

describe the role of antihypertensives in the treatment of heart failure

Answer 7

• decrease afterload so the heart pumps against less resistance.

Question 8

How does chronic atrial fibrillation affect a patient with heart failure?

Answer 8

• tachycardia and decreased atrial contraction worsens since left ventricular filling, so AF rate control is important.

Question 9

What agents should be used to achieve AF rate control?

Answer 9

• BB
• CCB

Question 10

what is BNP?

Answer 10

• Brain natriuretic peptide
  
  • It is released from the heart ventricle myocytes when they are stretched.

Question 11

What is a normal BNP?

Answer 11

< 100 pg/mL

Question 12

What is the BNP level seen in heart failure?

Answer 12

• > 500 pg/mL
• 100 - 500 pg/mL is inconclusive

Question 13

What are some common symptoms of leftsided heart failure?

Answer 13

• Weakness in dyspnea with exertion (sometimes even at rest)
• paroxysmal nocturnal dyspnea
• Orthopnea
• cough
• wheezing
• Pink, frothy sputum.

Question 14

What are some symptoms of right sided heart failure?

Answer 14

• abdominal pain and bloating
• nausea and vomiting
• Anorexia
• constipation.

Question 15

What are some physical signs of right sided heart failure?

Answer 15

• peripheral edema
• jugular venous distension
• hepatosplenomegaly
• hepatojugular reflux
• ascites

Question 16

What are some common CXR findings found in HF patients?

Answer 16

• pleural effusions
• pulmonary edema
• cephalization of pulmonary vessels
• cardiomegaly (cardiothoracic ratio > 50%)

Question 17

List cardiovascular diseases that lead to HF

Answer 17

• IHD
• HTN
• Valvular disease
• cardiac rhythm disorders
• cardiomyopathies

Question 18

Describe the mechanisms by which IHD may cause HF

Answer 18

1. Chronic ischemia causes sub-optimal myocardial function
2. Previous MI leading to LV dysfunction and subsequent remodeling

Question 19

What therapeutic strategies should be applied to HF patients with IHD?

Answer 19

• medical treatment for angina.
• Direct efforts to modify cardiac risk factors.
• Consideration of surgery( stenting, angioplasty, coronary artery bypass grafting)

Question 20

List the recommended lifestyle modifications for HF patients.

Answer 20

• dietary salt limitations
• exercise
• weight loss
• alcohol/smoking cessation

Question 21

what class of medication is used to treat fluid overload in both the acute and chronic settings?

Answer 21

• diuretics (usually loop diuretics e.g. furosemide)

Question 22

In the setting of heart failure, which antihypertensives have been shown to increase patient survival?
B

Answer 22

• BBs e.g Carvedilol, Metoprolol succinate
• ACE inhibitors
• ARBs
• Spironolactone.

Question 23

What are some physical findings of left-sided HF?

Answer 23

• bilateral pulmonary crackles(rales)
• S3 gallop
• displaced PMI (point of maximal impulse)

Question 24

How have BBs and ACE inhibitors specifically been shown to improve survival?

Answer 24

• by reducing heart remodeling and decreasing sympathetic tone ( less stress on the heart).

Question 25

What medications should be initiated for secondary prevention of further cardiovascular events in heart failure?

Answer 25

statins and aspirin.

Question 26

What additional medication combination may be of benefit to African American patients with heart failure?

Answer 26

hydralazine combined with nitrates.

Question 27

What general medical conditions may lead to heart failure?

Answer 27

• SLE
• hemochromatosis
• sarcoidosis
• cocaine abuse
• alcohol abuse.

Question 28

What inflammatory disease is a significant cause of heart failure?

Answer 28

• myocarditis

Question 29

list some causes myocarditis

Answer 29

• coxsackievirus B
• Influenza
• adenovirus
• HIV
• rheumatic fever
• Shaggers disease
• Lyme disease

Question 30

What lab findings may be abnormal in this patients with myocarditis?

Answer 30

• erythrocyte sedimentation rate elevation
• creatine kinase/troponin elevation.
• T wave inversion, oh ST elevation on the ECG.

Question 31

What are some common causes of acute exacerbation of heart failure ?

Answer 31

• infection
• anemia
• acute myocardial infarction
• Dietary indiscretions such as high salt or water intake.

Question 32

How do you manage new onset of acute exacerbation of heart failure recurring hospitalization?

Answer 32

• place patient on telemetry
• give IV diuretics
• monitor fluid balance and electrolytes closely
• administer oxygen
• control comorbidities especially hypertension,
• evaluate precipitating causes of heart failure.

Question 33

How do you evaluate precipitating causes of heart failure?

Answer 33

• ECG
• echocardiogram
• chest X ray
• blood tests.

Question 34

What blood test should you order in the setting of acute onset of heart failure?

Answer 34

• complete blood count
• basic metabolic panel
• liver function tests
• cardiac enzymes.