Clinical Syndrome of Heart Failure - HF 2

Question 1

NYHA functional class that is symptomatic with moderate exertion

Answer 1

• II

Question 2

NYHA functional class that is symptomatic with minimal exertion

Answer 2

• III

Question 3

NYHA functional class that is symptomatic at rest

Answer 3

• IV

Question 4

distended jugular veins is a symptom of

Answer 4

• right heart failure

Question 5

pulmonary rales is a symptom of

Answer 5

• left heart failure

Question 6

hepatomegaly is a symptom of

Answer 6

• right heart failure

Question 7

S3 or S4 gallop is a symptom of

Answer 7

• left heart failure

Question 8

peripheral edema is a symptom of

Answer 8

• right heart failure

Question 9

orthopnea is a symptom of

Answer 9

• left heart failure

Question 10

the most common cause of right heart failure

how

Answer 10

• left heart failure

- leads to pulmonary artery pressure which increases afterload on right ventricle

Question 11

most common presenting symptom of heart failure is

Answer 11

• dyspnea on exertion

Question 12

heart failure with preserved ejection fraction often due to

Answer 12

• diastolic dysfunction

Question 13

S3 heart sound due to

Answer 13

• early diastolic filling of a volume overloaded ventricle

Question 14

S4 heart sound due to

Answer 14

• late diastolic filling/atrial contraction into a stiff ventricle

Question 15

what can echocardiogram determine in heart failure that is very helpful

Answer 15

• ejection fraction

Question 16

BNP in heart failure released because of

Answer 16

• cardiomyocytes in response to stretch/strain

Question 17

what drugs do we give for heart failure

Answer 17

• ACE inhibitors
• ARBS
• aldosterone antagonists
• beta blockers

Question 18

neurohormonal effect of ACE inhibitors and ARBs

Answer 18

• reversal of remodeling
• decreased fibrosis
• decreased sodium and water retention
• decreased sympathetic tone

Question 19

hemodynamic effect of ACE inhibitors and ARBs

Answer 19

• afterload reduction via
• decreased SVR
• decreased BP

Question 20

result of reversing remodeling

Answer 20

• lowers wall stress

- decreases myocardial oxygen demand

Question 21

result of decreasing afterload

Answer 21

• decrease myocardial oxygen demand

- increases stroke volume

Question 22

contraindications for ACE inhibitors and ARBs

Answer 22

• angioedema to ACE inhibitors
• bilateral renal artery stenosis
• advanced renal dysfunction

Question 23

contraindications for aldosterone antagonists

Answer 23

• hyperkalemia

- advanced renal disease

Question 24

what beta blockers do we mostly use to treat heart failure

Answer 24

• carvedilol

- metoprolol

Question 25

big contraindication for beta blockers

Answer 25

- acute decompensated heart failure

Question 26

MOA of digoxin

Answer 26

- inhibits Na+ export via Na+/K+ ATPase | - promotes Ca2+ retention and increases contractile force

Question 27

downside of digoxin

Answer 27

- narrow therapeutic window

Question 28

do diuretics have any neurohormonal effects?

Answer 28

- no

Question 29

benefit of diuretic

Answer 29

- decrease preload which alleviates some symptoms of HF

Question 30

what does the QRS need to be in order to derive benefit from cardiac resynchronization therapy

Answer 30

- > 120

Question 31

signs and symptoms of acute decompensated heart failure

Answer 31

- cold and wet

Question 32

patients with ADHF require

Answer 32

- diuretic to relieve excess fluid retention

Question 33

patients with evidence of hypo perfusion require

Answer 33

- positive inotrope (beta blocker)