Chapter 51: Chronic Heart Failure

Question 1

Which of the following are correct statements about heart failure? (Select all that apply)

A. HF occurs when the heart is not able to supply sufficiently oxygen-rich blood to the body
B. Patients with HF can have EF either below or above 40%
C. CO = SVR x HR
D. EF is the volume of blood pumped by the heart in one minute
E. Cardiac index (CI) is equal to CO / BSA and relates the amount of blood pumped by the heart in one minute to the size of the patient

Answer 1

A,B, E are correct

Patients with EF 40% is indicative of diastolic dysfunction, now referred to as heart failure with preserved ejection fraction (HFpEF). HFpEF is characterized by impaired ability of the left ventricle to fill with blood.

C, D are incorrect
CO = SV (stroke volume) x HR; not systemic vascular resistance (SVR) x HR. Stroke volume, the volume of blood ejected by the left ventricle with each complete cardiac cycle, is comprised of SVR (afterload), preload, and contractility).

EF is the fraction of blood pumped out of a ventricle with each heartbeat. CO is the volume of blood pumped by the heart in one minute

Question 2

Which of the following drugs can cause or worsen HF?

A. Pioglitazone
B. Ibuprofen
C. Doxorubicin
D. Toprol XL®
E. Itraconazole

Answer 2

A, B, C, and E are correct

Anthracyclines such as doxorubicin (Adriamycin®, Doxil®) are notorious for causing damage to the heart which is why they have lifetime cumulative dose limits. NSAIDs and TZDs can both worsen HF.