(hans) cardio 86 - 91

Question 1

Name 7 major clinical symptoms of CHF

Answer 1

1. dyspnea on exertion
2. orthopnea (worse when lying flat, relieved when sitting up)
3. peripheral edema
4. rales on lung exam
5. JVD
6. S3 gallop

Question 2

name 3 key features of panic attack

Answer 2

circumoral numbness, caffeine use, hx of anxiety

Question 3

3 key features of tamponade?

Answer 3

pulsus paradoxus, dec heart sound, JVD

Question 4

dx?

a pt who had recent anesthetic use, brown blood not improved with oxygen with cyanosis but has clear lung

Answer 4

methemoglobinemia

Question 5

what one test must be done for every CHF pts?

Answer 5

echo to evaluate ejection fraction

Question 6

Best initial test to measure ejection fracture?

Answer 6

Transthoracic echo (TTE)

Question 7

What is the most accurate test for ejection fraction?

Answer 7

Multiple gated acquisition scan or nuclear ventriculography

Question 8

60 y/o old male with lymphoma comes in to check the heart. You are trying to give the max dose of chemo, what test should you be doing to assess the heart?

Answer 8

Nuclear ventriculography

Question 9

Which testing modality gives the most precise evaluation of wall motion abnormality?

Answer 9

Nuclear ventriculography

Question 10

50 y/o male comes in with acute shortness of breath. You are not sure if CHF is causing the symptom and the echo is not available right away. What is your best next step?

Answer 10

Get BNP since if it’s normal you can rule out CHF.

Question 11

A pt comes in with acute shortness of breath and you are not certain if it is CHF or ARDS, what test would you want to use to differentiate?

Answer 11

Swan ganz Rt. Heart catheterization

Question 12

2 side effects of spironolactone?

Answer 12

Gynecomastia and hyperkalemia

Question 13

A pt with CHF was given spironolactone then develops gynecomastia, what is your next best step?

Answer 13

Give eplerenone

Question 14

True of false

Diuretics lowers CHF mortality

Answer 14

False (diuretics just control symptoms)

Question 15

Ture or false

Digoxin lowers CHF mortality

Answer 15

False (just control symptoms)

Question 16

What 2 cardiac drugs should NOT be used for diastolic dysfunction?

Answer 16

Digoxin, spironolactone

Question 17

What cardiac drug should NOT be used for systolic dysfunction?

Answer 17

Calcium channel blockers

Question 18

What parameter determines if CHF is systolic/diastolic dysfunction

Answer 18

Ejection pressure (if preserved then It’s diastolic dysfunction)

Question 19

What 2 drugs are beneficial for diastolic dysfunction CHF?

Answer 19

Beta blockers, diuretics

Question 20

Name 5 major therapies that benefit systolic dysfunction

Answer 20

1. ACEIs/ARBs
2. Beta blocker
3. Spironolactone or eplerenone
4. Hydralazine/nitrates
5. Implantable defibrillator

Question 21

2 most common cause of death for CHF?

Answer 21

Arrhythmia, sudden death

Question 22

what are the 2 devices for CHF treatment?

Answer 22

1. implantable defibrillator

2. biventricular pacemaker

Question 23

what is the indication for implantable defibrillator?

Answer 23

ischemic cardiomyopathy and ejection fraction below 35%

Question 24

what is the indication for biventricular pacemaker?

Answer 24

dilated cardiomypathy with ejection fraction under 35% plus QRS above 120 milliseconds

Question 25

what drug is contraindicated in hypertrophic obstructive cardiomyopathy? and why?

Answer 25

diuretics, b/c it increases the obstruction

Question 26

name the 3 beta blockers that are shown to have evidence to give benefits

Answer 26

metoprolol, bisoprolol, carvedilol

Question 27

name the 2 beta blokcers that are beta 1 specific

Answer 27

metoprolol, bisoprolol

Question 28

mech of carvedilol?

Answer 28

non-specific beta blocker plush alpha 1 blocker