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keystone: exam 1 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Right sided elevated filling pressures cause _____

A

edema, ascites

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2
Q

Name the NYHAF Class:

Ordinary physical activity, no symptoms

A

1

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3
Q

Name the NYHAF Class:

Less than ordinary physical activity causes symptoms

A

3

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4
Q

Name the NYHAF Class:

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

A

4

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5
Q

Name the NYHAF Class:

Ordinary physical activity causes symptoms

A

2

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6
Q

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.

A

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

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7
Q

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.

A

True

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8
Q

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

A

Left

base

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9
Q

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

A

Right

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10
Q

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

A

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.

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11
Q

Left sided heart failure presents with ____ upon auscultation.

A

apical S3 gallop

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12
Q

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

A

False. Narrowed pulse pressure

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13
Q

Left sided elevated filling pressures cause _____

A

dyspnea

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14
Q

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

A

heart failure as cause of dyspnea

BUT NOT specific for cardiac etiology of dyspnea

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15
Q

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

A

C. Decreased contractility in systolic dysfunction

Decreased compliance in diastolic dysfunction

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16
Q

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

A

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.

17
Q

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

A

Volume overload

18
Q

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

A

Pressure overload

19
Q

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

A

Pericardial
chronic
peripheral edema, ascites

20
Q

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

A

Pericardial
acute
hypotension

21
Q 
Which of the following is NOT a treatment of acute non-hypotensive pulmonary edema?
A. Morphine IV
B. Furosemide IV
C. Vasoconstrictors 
D. Oxygen
A

C. Vasodilators for pulmonary edema w/ systemic arterial HTN

22
Q

Name the stage of heart failure:

Structural heart disease w/ prior or current symptoms of HF

A

C

23
Q

Name the stage of heart failure:

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

A

A

24
Q

Name the stage of heart failure:

Refractory HF requiring specialized interventions

A

D

25
Q

Name the stage of heart failure:

Structural heart diseae w/o signs/symptoms of HF

A

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

26
Q

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

A

A

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

27
Q

Name the short acting ACE-I

A

Captopril:

28
Q

ACE-I or ARB used if ____

A

decreased left ventricular ejection fraction

29
Q

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

A

False. Vice versa

30
Q 
Which of the following is a side effect of ACE-I?
A. Orthostatic hypertension
B. Hypokalemia
C. Decreased BUN/Creatinine
D. Angioedema
A

D

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

31
Q

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

A

False. Bilateral

32
Q 
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
A

C. Improves symptoms, does NOT prolong survival

33
Q

Treat with ____ if PH of MI or decrease LVEF.

A

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

34
Q

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

A

Severe renal insufficiency

Baseline hyperkalemia

35
Q

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

A

Inplantable cardioverter-defibrillator (ICD)

36
Q

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

A

Biventricular pacing = cardiac resychronization therapy

37
Q

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

A

Digoxin

keystone: exam 1 (12 decks)

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