CHF and CMP Flashcards
Several nonspecific measures may be important, including avoidance of exercise, electrocardiographic monitoring, antiarrhythmic drugs in selected patients, treatment of HF, and anticoagulation in pts with…
myocarditis
The definitive diagnosis of myocarditis can be made only by …
endomyocardial biopsy
The most frequently implicated viruses in … are Coxsackie B virus, adenovirus, hepatitis C, cytomegalovirus (CMV), echovirus, influenza virus, Epstein-Barr virus (EBV), and the viruses of childhood exanthematous diseases.
myocarditis
The most successful therapeutic regimen of the patient with ascites is the combination of single morning oral doses of… (2 drugs), beginning with 100 mg and 40 mg, respectively.
spironolactone and furosemide
Muscular dystrophy (Duchenne, Becker, Emery-Dreifuss) can be associated with… (CV conditions)
cardiomyopathy and cardiac rhythm disturbances.
… is most frequently used in severe, medically refractory heart failure and cardiogenic shock and should not be routinely used in sepsis because of the risk of hypotension.
Dobutamine
This invasive procedure is performed every 6-12 months post cardiac transplant:…
coronary angiography.
… is the name given to the pathologic ventricular dilatation that occurs after AMI.
Ventricular remodeling
A minority of CHF patients with severely impaired renal function need… (intervention).
fluid restriction
A minority of CHF patients with significant hyponatremia need… (intervention).
fluid restriction
Although routine use of… in patients with mild CHF is not recommended, it may be reasonable to use this agent in place of K replacement in those with diuretic-induced hypokalemia.
spironolactone
In order to initiate a progressive exercise program, CHF patients need a…
submaximal or maximal monitored exercise test.
In patients presenting with acute CHF decompensation, the dose of beta-blockers should be reduced… % and tapered gradually if necessary.
50
The vasodilator heart failure trial (V-HeFT) was the first large scale trial in CHF showing a reduced mortality by 34% in patients treated with…
hydralazine 50mg and isosorbide dinitrate 40mg q6h.
… (morphology) is the greatest in endurance sports like rowing and cycling.
Athletic hypertrophy
The combination of furosemide and a… can be especially helpful when edema is refractory to either agent alone.
thiazide
Any patient with… cardiomyopathy should be strongly counseled against future pregnancies.
postpartum
A minority of CHF patients with refractory fluid retention need… (intervention).
fluid restriction
The only use for calcium blockers in CHF is for… , but not for CHF itself, and the only drug should be amlodipine.
angina or HTN
High… intake in patients on diuretics increases potassium loss and exacerbate hypokalemia.
salt
When the sum of the posterior wall and septum widths divided by the end-diastolic LV diameter is more than… , in a patient with CHF and normal EF, it can be assumed that diastolic dysfunction, LV hypertrophy or infiltrative cardiomyopathy is present.
0.45
This class of diuretics… is contraindicated in patients allergic to sulfonamide-derived drugs.
thiazide diuretics
… , apart from being the most widely used calcium blocker in hypertrophic cardiomyopathy, has a beneficial effect on angina and dyspnea and also improves exercise capacity.
Verapamil
… (class) most often are used to treat patients with impaired cardiac function and medically refractory heart failure, but their vasodilatory properties limit their use in hypotensive patients.
Phosphodiesterase inhibitors (amrinone and milrinone)
Digoxin is used in chronic heart failure when the patients are in sinus rhythm and still… despite optimal therapy with diuretics (including spironolactone), ACEI, and BB.
symptomatic
The first time a study showed that calcium blockers can be safely administered in CHF patients was PRAISE I on… (drug).
amlodipine
The characteristic gross pathology of… is dilation of all four chambers.
idiopathic dilated cardiomyopathy (IDCM)
… is the most common INHERITED CV dz, affecting 1:500 general population.
HCM (hypertrophic cardiomyopathy)
Chagas’ disease, disease of South and Central America caused by the parasite Trypanosoma cruzi, causes in 10-30% of patients serious or fatal inflammation of the brain and… (CV condition).
myocarditis.
… is characterized by a decrease in the E/A ratio and a prolonged E deceleration time.
Early stage LV diastolic dysfunction
… is characterized by a restrictive pattern with a high E/A ratio and a shortened E deceleration time.
Late stage LV diastolic dysfunction
Patients with LVEF<30% measured at least 1 month after AMI or 3 months after coronary intervention is class IIa indication for…
ICD therapy. (ACC/AHA/NASPE guidelines)
The natural role of… is to attenuate the release and peripheral actions of noradrenaline, renin and vasopressin.
natriuretic peptides
Hyponatremia may occur in severe CHF and is a sign of…
worse prognosis.
An increase in the amplitude of the R wave and a decrease in the depth of the S wave in the right precordial leads (V1 and V2), causing an increase in the R:S ratio greater than 1 occurs in…
RVH.
The most effective intervention for relief of symptoms in CHF is…
exercise training.
The most common etiology for CHF in adults is…
CAD.
… are LV structures more easily visualized in patients with cardiomyopathy and dilated hearts than in normal hearts.
The pseudochordae
In normal individuals, early velocities exceed later velocities and the E to A ratio is typically greater than…
1.2.
Predicting RVH from ECG: the sum of S in V5 or V6 plus R in V1 is greater than…
1 mV (10 mm)
The follow-up in asymptomatic patients with mitral stenosis consists of echocardiography only when…
there is a change in the clinical status.
Predicting RVH from ECG: R in V1 is equal to…
0.7 mV (7 mm)
R wave < S wave in V6 occurs in…
RVH.
Predicting RVH from ECG: R in V1 is equal to… when associated with RBBB.
1.5 mV (15 mm)
Predicting LVH from ECG using Cornell voltage criteria for WOMEN requires that the sum of S in V3 plus R in aVL is greater than…
2.0 mV (20 mm)
Predicting LVH from ECG using Cornell voltage criteria for MEN requires that the sum of S in V3 plus R in aVL is greater than…
2.8 mV (28 mm)
A new class I indication supports adding … to standard medical therapy (including ACE-I and beta-blockers) in BLACK PATIENTS with NYHA functional class III or IV HF.
an isosorbide dinitrate-hydralazine combination
Predicting LVH from ECG using Sokolow-Lyon index requires that the R wave in aVL is greater than or equal to…
1.1mV (11 mm)
In the RALES randomized, placebo-controlled trial of… significantly reduced mortality risk among patients with severe heart failure and left-ventricular systolic dysfunction (N Engl J Med 1999; 341:709).
25 mg daily of spironolactone
This review found no significant difference between… (class) and ACEIs in all cause mortality or hospital admission in people with New York Heart Association class II–IV heart failure.
angiotensin receptor blockers
Phenylephrine (Neosynephrine®) is contraindicated if the SVR is…
> 1200 dynes x sec/cm5
Some authors recommend keeping the SVR approximately… to avoid excessive afterload and to minimize complications from profound vasoconstriction.
700 to 1000 dynes x sec/cm5
… is used most commonly to treat septic shock.
Norepinephrine
… is most often used in hypotension due to sepsis or cardiac failure, where it should be started at 2 mcg/kg per minute and then titrated to a desired physiologic effect rather than a predicted pharmacologic range.
Dopamine
Characteristics of patients in whom… is strongly supported by RCTs are: sinus rhythm, LVEF 120ms, NYHA functional class III or IV and on maximal pharmacological therapy for heart failure.
CRT
… is useful in the setting of hypotension with an SVR <700 dynes x sec/cm5 (eg, hyperdynamic sepsis, neurologic disorders, anesthesia-induced hypotension).
Phenylephrine (Neosynephrine®)
In…, there is diastolic flattening of the ventricular septum so that the left ventricular geometry in diastole assumes a D shape rather than circular geometry. Because this is a low-pressure phenomenon, the left ventricle becomes circular in early systo
a pure volume overload
… results in flattening of the septum both in diastole and systole.
A right ventricular pressure overload
… is characterized by paradoxical anterior motion of the septum in systole, with preserved myocardial thickening.
The postoperative septum; it is a phenomenon seen in any form of cardiac surgery in which the pericardium has been opened
The postoperative septum resolves in… after surgery.
3 to 5 years
A strong association between … class and both maternal and fetal complications was found in patients with valvular heart disease.
NYHA functional
Heart failure with normal systolic function but abnormal diastolic relaxation accounts for … of patients presenting with congestive heart failure.
30 - 40 %
Patients with dilated CMP, QRDS>120ms, EF<35%, and severe CHF (NYHA III-IV) despite optimal medical therapy should undergo…
CRT (cardiac resynchronization therapy).
The most common of infiltrative cardiomyopathy is …
cardiac amyloidosis.
All patients undergoing… will need therapy for their lipid abnormalities due to higher than expected risk of atherosclerotic events.
organ transplant
The therapy of choice for familial Mediterranean fever is… shown to prevent both the acute febrile attacks and the development of amyloidosis.
colchicine
A trial of colchicine or a genetic search for pyrin mutation could establish the diagnosis of…
familial Mediterranean fever.
The prophylaxis in familial Mediterranean fever consists of daily…
colchicine.
If a patient with HAPE (high altitude pulmonary edema) can not descent and receive supplemental oxygen, administration of oral… is recommended.
nifedipine
To prevent HAPE (high altitude pulmonary edema), slow ascent, supplemental oxygen and… prophylaxis are indicated.
nifedipine
The use of long-term oxygen therapy is indicated in patients with PaO2 less then… without evidence of cor pulmonale.
55
The use of long-term oxygen therapy is indicated in patients with PaO2 less then… if evidence of cor pulmonale exists.
60
… is characterized on intestinal biopsy by deposits of birefringence with polarized light after staining with Congo red.
Amyloidosis
