Cardiomyopathies And Heart Failure

Question 1

What can cause a systolic murmur?

Answer 1

Aortic stenosis 
HOCM
Flow
Pulmonic stenosis 
Mitral regurgitation
Mitral valve prolapse
Tricuspid regurgitation
Ventricular septal defect

Question 2

What can cause a diastolic murmur?

Answer 2

Aortic regurgitation
Pulmonary regurgitation
Mitral stenosis
Tricuspid stenosis

Question 3

What are the signs of heart failure?

Answer 3

1. High right pressures: increased JVP, hepatomegaly, ascites, edema
2. Pulmonary htn: parasternal lift, palpable and loud P2
3. High left pressures: tachypnea,
   Inspiratory crackles, S3, hypoxia
4. Low cardiac output: decreased LOC, cool extremities, low urine

Question 4

Which drugs prolong survival in heart failure?

Answer 4

1. Ace inhibitors
2. Angiotensin receptor blockers
3. Beta blockers
4. Aldosterone inhibitors (in NYHA 3-4)

Question 5

Which drugs only improve symptoms in heart failure?

Answer 5

1. Diuretics
2. Nitrates
3. Digoxin

Question 6

How is heart failure with preserved ejection fraction managed?

Answer 6

No medical tx for survival benefit.

Question 7

What drugs can control atrial fibrillation?

Answer 7

1. Propafenone: combo therapy
2. Sotalol: never use with long QT
3. Amiodarone

Question 8

How does heart failure affect coronary perfusion?

Answer 8

Heart failure increases left ventricular end diastolic pressure, which decreases the gap between aortic pressure and LV pressure, which leaves less of a gradient, therefore decreases coronary perfusion pressure

Question 9

What tests might show heart failure?

Answer 9

Chest X-ray: cardiomegaly, bat wing opacity around hilum, Kerley B lines
NT-proBNP
Echo: good for diagnosing mechanism of heart failure

Question 10

What can cause left sided heart failure?

Answer 10

1. Aortic coarctation/ severe HTN
2. Aortic valve stenosis or insufficiency
3. Left ventricular systolic or diastolic dysfunction
4. Mitral valve regurgitation or prolapse

Question 11

What can cause isolated right heart failure?

Answer 11

1. Lung disease with pulmonary HTN
2. Pulmonic valve disease
3. RV dysfunction
4. Tricuspid valve disease

Question 12

What is the NYHA functional classification?

Answer 12

1. No SX within normal range of activities
2. SX with ordinary activities
3. SX with less than ordinary activity
4. SX at rest

Question 13

What maladaptive responses does the body have to decreased cardiac output?

Answer 13

1. Increased sodium and water retention: increases SV initially but over time causes congestion and progressive LV remodelling
2. Increased SVR: increases your blood pressure (good) at first, but over time decreases stroke volume and co

Question 14

How is acute decompensated heart failure treated?

Answer 14

1. ID cause
2. Basic ABCs
3. Nitrates and diuretics
4. Morphine
5. Beta blockers will make people feel worse!

Question 15

How can refractory heart failure be treated?

Answer 15

1. Optimize medical tx
2. Biventricular pacing
3. Left ventricular assist device
4. Transplant

Question 16

What causes dilated cardiomyopathy?

Answer 16

Idiopathic, peripartum, infection/myocarditis, toxins, metabolic issues, inflammatory disease,

Question 17

What causes restrictive cardiomyopathy?

Answer 17

Amyloidosis, idiopathic, scleroderma, sarcoidosis, hemachromatosis

Question 18

What are the signs of poor tissue perfusion?

Answer 18

Poor urine output
Cool extremities
Tachycardia
Hypotension
Agitation confusion