CHF

Question 0

Diastolic dysfunction? Caused by?

Answer 0

Increased diastolic filling pressure. Caused by impaired diastolic relaxation and decreased ventricular compliance

Question 1

Physiologic complications ofAcute heart failure? May proceed to?

Answer 1

Pulmonary edema and low cardiac output. Cardiogenic shock.

Question 2

Systolic dysfunction? Caused by?

Answer 2

Low cardiac output (low EF) caused by impaired systolic function

Question 3

Cardiac remodeling due to?

Answer 3

Increased cardiac loading (preload and afterload)

Question 4

Congestive heart failure?

Answer 4

Heart cannot meet metabolic needs of body but maintains normal ventricular filling pressures

Question 5

Neuroendocrine responses to CHF?

Answer 5

Activation of RAAS and increased sympathetic activity

Question 6

Symptoms of forward failure?

Answer 6

Forward failure is low cardiac output. Symptoms include fatigue lethargy and hypertension

Question 7

Backward failure symptoms?

Answer 7

Backward failure is increased filling pressures or diastolic dysfunction. Symptoms include dyspnea, peripheral edema and ascites

Question 8

Patients with CHF have a high mortality if?

Answer 8

Have symptoms at rest, or have an ejection fraction lower than 20%

Question 9

Death associated with CHF may occur from?

Answer 9

Cardiogenic shock or sudden death from ventricular arrhythmias

Question 10

Chronic pressure overloads that result in CHF?

Answer 10

Aortic stenosis, hypertension

Question 11

Chronic volume overload that result in CHF?

Answer 11

Mitral regurgitation

Question 12

Infiltrative diseases that can result in CHF?

Answer 12

Amyloidosis, hemochromatosis

Question 13

Myocardial injuries that could result in congestive heart failure?

Answer 13

Alcohol, cocaine, ischemic cardiomyopathy, rheumatic fever, viral myocarditis, adriamycin

Question 14

For patients with heart failure appropriate investigation may include?

Answer 14

Electrocardiography, cardiac stress testing, coronary angiography, biopsy

Question 15

Heart failure symptoms are usually caused by? Are relieved by?

Answer 15

Caused by low cardiac output and fluid overload. Believed with dietary sodium restriction and loop diuretics

Question 16

Drugs that have been shown to reduce mortality in patients with impaired systolic function and moderate to severe symptoms?

Answer 16

ACE inhibitors, Angiotension receptor blockers, beta blockers

Question 17

Beta blockers that have been shown to reduce mortality in patients with impaired systolic function?

Answer 17

Carvedilol, metoprolol, bisoprolol

Question 18

ACE inhibitors are less effective for CHF in what patients?

Answer 18

Black patients

Question 19

In patients who cannot tolerate ACE inhibition use what drugs to lower mortality?

Answer 19

Hydralazine with nitrates

Question 20

Drug that can be added to CHF regimens for additional symptom relief but provides no survival benefit?

Answer 20

Digoxin

Question 21

Mechanism for beta blockers in CHF?

Answer 21

Prevent and reverse adrenergically mediated intrinsic myocardial dysfunction and remodeling

Question 22

Mechanism of ACE inhibitors in CHF?

Answer 22

Reduces preload and afterload and prevents remodeling. Drug of choice in CHF because of survival benefit

Question 23

Mechanism of nitrates and nitrates in CHF?

Answer 23

Reduce preload and clear pulmonary congestion

Question 24

Mechanism of action of diuretics in CHF?

Answer 24

Used to decrease preload especially in acute settings

Question 25

What is the most likely cause of Moderately severe congestive heart failure in a 55-year-old man in the United States?

Answer 25

Ischemic cardiomyopathy due to coronary atherosclerosis

Question 26

Determining impaired systolic function as cause of CHF versus impaired diastolic function?

Answer 26

Ejection fraction less than 40%