Chapter 264 - Approach to the Patient with Possible Cardiovascular Disease

Question 1

Name the classes of New York Heart Association Functional (NYHA) Classification for Heart Failure.

Answer 1

Class I - No limitation of physical activity. No symptoms with ordinary exertion.
Class II - Slight limitation of physical activity. Ordinary activity causes symptoms.
Class III - Marked limitation of physical activity. Less than ordinary activity causes symptoms. Asymptomatic at rest.
Class IV - Inability to carry out any physical activity without discomfort. Symptoms at rest.

Question 2

Age-adjusted deah rates for coronary heart disease have declined by two-thirds in the last four decades in the United States.
True or False?

Answer 2

True.
The death rates reductions are due to “identification and reduction of risk factors as well as improved treatments and interventions for the management of coronary artery disease, arrythmias and heart failure.”

Question 3

Which percentage of deaths due to cardiovascular disease are classified as sudden death?

Answer 3

“Aproximately one-fourth.”

Question 4

The number of deaths related to cardiovascular disease is higher in women than in men.
True or False?

Answer 4

True.
“In fact, the percentage of all deaths secondary to cardiovascular disease is higher among women (43%) than among men (37%). In addition, although the absolute number of deaths secondary to cardiovascular disease has declined over the past decades in men, this number has actually risen in women.”

Question 5

The first clinical manifestation of idiopathic dilated cardiomiopathy is usually syncope or even sudden death.
True or False?

Answer 5

False.
“(…) or a previously asymptomatic patient with hypertrophic cardiomyopathy, or with a prolonged QT interval whose first clinical manifestation is syncope or even sudden death”.
“Patients with valvular heart disease or idiopathic dilated cardiomyopathy, by contrast, may have a prolonged course of gradually increasing dyspnea and other manifestations of chronic heart failure that is punctuated by episodes of acute deterioration only late in the course of the disease.”

Question 6

Raynaud’s syndrome might be associated with pulmonary hypertension.
True or False?

Answer 6

True.
“(…) the presence of pulmonary hypertension and cor pulmonale should be considered in a patient with scleroderma or Raynaud’s syndrome.” Not to be confounded with Raynaud’s Disease.