Heart Failure

Question 1

Right sided elevated filling pressures cause _____

Answer 1

edema, ascites

Question 2

Name the NYHAF Class:

Ordinary physical activity, no symptoms

Answer 2

1

Question 3

Name the NYHAF Class:

Less than ordinary physical activity causes symptoms

Answer 3

3

Question 4

Name the NYHAF Class:

Symptoms may present at rest. Any physical activity increases symptoms.

Answer 4

4

Question 5

Name the NYHAF Class:

Ordinary physical activity causes symptoms

Answer 5

2

Question 6

T/F: Once a patient is classified in a NYHAF class, he can not go back down to a lower class if his symptoms get better.

Answer 6

False. Pts can be reclassified depending on symptoms in the NYHAF classification.

Question 7

T/F: Once a patient is classified in a stage of heart failure, he can not go back down to a lower stage if his symptoms get better.

Answer 7

True

Question 8

(Left/right) sided heart failure presents with pulmonary crackles most prominent at (base/apex) posteriorly.

Answer 8

Left

base

Question 9

(Left/right) sided heart failure presents with dependent edema.

Answer 9

Right

Question 10

Hepatojuguar reflux sign (HJR) is used to assess for _____

Answer 10

right sided heart failure.

HJR = pressing/examining hand into pt’s right upper quadrant –> should not cause elevation of height in JVP. + if it does.

Question 11

Left sided heart failure presents with ____ upon auscultation.

Answer 11

apical S3 gallop

Question 12

T/F: Heart failure presents with widened pulse pressure and tachycardia at rest.

Answer 12

False. Narrowed pulse pressure

Question 13

Left sided elevated filling pressures cause _____

Answer 13

dyspnea

Question 14

Pro-BNP/BNP > 500 pg/ml suggests ____

Answer 14

heart failure as cause of dyspnea

BUT NOT specific for cardiac etiology of dyspnea

Question 15

All of the following are signs of systolic dysfunction EXCEPT:
A. Enlarged end-diastolic volume
B. Cardiomegaly on CXR
C. Decreased compliance
D. Significantly decreased ventricular ejection fraction
E. S3 gallop

Answer 15

C. Decreased contractility in systolic dysfunction

Decreased compliance in diastolic dysfunction

Question 16

Which of the following is a characteristic of diastolic dysfunction?
A. Enlarged EDV
B. Severe cardiomegaly
C. Decreased contractility
D. Decreased compliance
E. Decreased ventricular ejection fraction
F. S4 gallop

Answer 16

D, F (Gotcha! There are 2 correct answers)

All other’s are signs of systolic dysfunction. Diastolic dysfunction have relatively normal signs other than decreased compliance.

Question 17

Valve insufficiency and shunts cause what mechanical cause of heart failure?

Answer 17

Volume overload

Question 18

Valve stenosis and HTN cause what mechanical cause of heart failure?

Answer 18

Pressure overload

Question 19

Constrictive pericarditis is a ____ cause of heart failure characterized by (acute/chronic) presentation w/ _____

Answer 19

Pericardial
chronic
peripheral edema, ascites

Question 20

Cardiac tamponade is a ____ cause of heart failure characterized by (acute/chronic) presentation w/ ____

Answer 20

Pericardial
acute
hypotension

Question 21

Which of the following is NOT a treatment of acute non-hypotensive pulmonary edema?
A. Morphine IV
B. Furosemide IV
C. Vasoconstrictors 
D. Oxygen

Answer 21

C. Vasodilators for pulmonary edema w/ systemic arterial HTN

Question 22

Name the stage of heart failure:

Structural heart disease w/ prior or current symptoms of HF

Answer 22

C

Question 23

Name the stage of heart failure:

High risk of HF w/o structural heart disease or symptoms of HF

Answer 23

A

Question 24

Name the stage of heart failure:

Refractory HF requiring specialized interventions

Answer 24

D

Question 25

Name the stage of heart failure: | Structural heart diseae w/o signs/symptoms of HF

Answer 25

B Ex: previous MI Ex: Left ventricular hypertrophy secondary to HTN or valve disease/asymptomatic valve disease

Question 26

Which of the following is NOT a class of drug that should be avoided since they can exacerbate HF? A. Beta blockers B. Anti-arrhythmic drugs C. Calcium channel blockers (verapamil, diltiazem) D. NSAIDs

Answer 26

A B. Except amidarone, dofetilide C. Except vasoselective ones D. Except low dose aspirin

Question 27

Name the short acting ACE-I

Answer 27

Captopril:

Question 28

ACE-I or ARB used if ____

Answer 28

decreased left ventricular ejection fraction

Question 29

T/F: If problem w/ orthostatic hypotension or rising BUN, you should consider decreasing ACE-I before decreasing diuretics

Answer 29

False. Vice versa

Question 30

``` Which of the following is a side effect of ACE-I? A. Orthostatic hypertension B. Hypokalemia C. Decreased BUN/Creatinine D. Angioedema ```

Answer 30

D A. Orthostatic hypotension B. Hyperkalemia C, Increased BUN/creatinine due to volume deletion

Question 31

T/F: Unilateral renal artery stenosis is contraindicated for ACE-I

Answer 31

False. Bilateral

Question 32

``` Which of the following does NOT improve survival in heart failure patients? A. ACE-I B.Angiotensin Receptor Blockers C. Digoxin D. Beta-adrenergic blockers E. Aldosterone antagonists F. Hydralazine + isosorbide dinitrate ```

Answer 32

C. Improves symptoms, does NOT prolong survival

Question 33

Treat with ____ if PH of MI or decrease LVEF.

Answer 33

Beta-adrenergic blockers Carvedilol: non-selective Metoprolol: beta-1 selective

Question 34

Aldosterone antagonists (spironolactone, eplerenone) is contraindicated for ____ (2)

Answer 34

Severe renal insufficiency | Baseline hyperkalemia

Question 35

If LVEF less than 30-35%, consider treatment w/ ____

Answer 35

Inplantable cardioverter-defibrillator (ICD)

Question 36

If LVEF less than 35% & wide QRS duration, consider treatment w/ ____

Answer 36

Biventricular pacing = cardiac resychronization therapy

Question 37

Consider treatment with ____ if pt has left ventricular systolic dysfunction who remain symptomatic dispite therapy w/ diuretics, ACE-Is and beta blockers.

Answer 37

Digoxin