Cardiovascular Diseases - Heart Failure and Valvular Heart Diseases

Question 1

most common cause of systolic dysfunction that leads to left-sided heart failure

Answer 1

Coronary Artery Disease (CAD)

Question 2

most common cause of diastolic dysfunction that leads to left-sided heart failure

Answer 2

Concentric Left Ventricular Hypertrophy (LVH) due to HPN

Question 3

most common cause of right-sided heart failure

Answer 3

L-sided heart failure

Question 4

Earliest CARDINAL SYMPTOM of L-sided heart failure

Answer 4

Dyspnea

Question 5

Earliest CARDINAL SIGN of L-sided heart failure

Answer 5

L-sided S3

Question 6

Presentation of L-sided heart failure

Answer 6

• Dyspnea
• L-sided S3
• PND
• Orthopnea
• MV regurgitation
• presence of brain natriuretic peptide (BNP)
• siderophages (hemosiderin-laden macrophages or heart failure cells)
• pulmonary edema (septal edema, peribronchiolar edema)

Question 7

Presentation of R-sided heart failure

Answer 7

• peripheral ankle edema (hallmark of R-sided heart failure)
• neck vein engorgement
• tricuspid regurgitation
• ascites
• chronic passive congestion of the liver (nutmeg liver, cardiac cirrhosis)

Question 8

MOST sensitive index of cardiac function

Answer 8

ejection fraction

Question 9

important bedside measurement to estimate the volume status

Answer 9

JVP (internal jugular vein preferred)

Question 10

predominant cause of HF and responsible for 60-75% of HF in industrialized countries

Answer 10

Coronary Artery Disease

Question 11

Cardinal symptoms of heart failure

Answer 11

fatigue and shortness of breath

Question 12

most important mechanism of dyspnea in heart failure

Answer 12

pulmonary congestion with accumulation of insterstitial or intra-alveolar fluid, which activates juxtacapillary J receptors

Question 13

most useful test in assessment of LV function

Answer 13

2d-echo with doppler studies

Question 14

gold standard for assessment of LV mass and volume

Answer 14

MRI

Question 15

only pharmacologic agents that can adequately control fluid retention in advanced HF

Answer 15

diuretics

Question 16

major problem in aldosterone antagonists

Answer 16

development of life-threatening hyperkalemia

Question 17

cornerstones of moden therapy for HP with a depressed EF

Answer 17

ACE-I/ARBs and Beta Blockers

Question 18

most common side effect of all vasodilating agents

Answer 18

hypotension

Question 19

most common side effect of IV or oral nitrates

Answer 19

headache

Question 20

most commonly used inotropic agent for the treatment of acute HF

Answer 20

dobutamine

Question 21

first choice for therapy in which modest ionotropy and pressor support are required

Answer 21

dopamine

Question 22

most common reason for re-hospitalization in heart failure

Answer 22

failure to meet criteria for discharge

Question 23

most common symptom of cor pulmonale

Answer 23

dyspnea

Question 24

opening snap, rheumatic heart disease, atrial fibrillation

Answer 24

mitral stenosis

Question 25

pansystolic murmur, can be due to mitral valve prolapse (MVP)

Answer 25

mitral regurgitation

Question 26

midsystolic click, associated with Marfan's

Answer 26

mitral valve prolapse

Question 27

2 Types: calcified (elderly) or congenital (newborn), causes syncope in exercise

Answer 27

aortic stenosis

Question 28

widened pulse pressure; corrigan, de musset, quincke, muller, durozeiz, traube, hill, becker signs; austin-flint murmur

Answer 28

Aortic Regurgitation/insufficiency

Question 29

secondary to pulmonary hpn, graham-steell murmur

Answer 29

pulmonary regurgitation

Question 30

IE in IV drug abusers, carcinoid heart disease, pulsating liver, giant C-V wave jugular venous pulses

Answer 30

tricuspid regurgitation

Question 31

carcinoid heart disease

Answer 31

pulmonary stenosis

Question 32

leading cause of mitral stenosis

Answer 32

rheumatic heart disease

Question 33

most prominent location of kerley b lines

Answer 33

lower and mid-lung fields

Question 34

papillary muscle usually involved in acute MR because of single blood supply

Answer 34

posteromedial papillary muscle

Question 35

most complaints in chronic severe MR

Answer 35

fatigue, exertional dyspnea, and orthopnea

Question 36

most common ecg finding in MVP

Answer 36

normal

Question 37

most important finding on auscultation in MVP

Answer 37

mid- or late (nonejection) systolic click

Question 38

most common congenital heart valve defect

Answer 38

bicuspid aortic valve disease

Question 39

three cardinal symptoms of AS

Answer 39

exertional dyspnea + angina pectoris + syncope

Question 40

most common cause of midsystolic murmur in an adult

Answer 40

aortic stenosis

Question 41

murmur that is always related to structural heart disease

Answer 41

diastolic murmurs (Grade I-II systolic murmurs are usually benign)

Question 42

classic cause of a mid-to-late diastolic murmur

Answer 42

mitral stenosis

Question 43

classic example of a continuous murmur

Answer 43

patent ductus arteriosus (PDA)