Heart Failure Flashcards
Right sided elevated filling pressures cause _____
edema, ascites
Name the NYHAF Class:
Ordinary physical activity, no symptoms
1
Name the NYHAF Class:
Less than ordinary physical activity causes symptoms
3
Name the NYHAF Class:
Symptoms may present at rest. Any physical activity increases symptoms.
4
Name the NYHAF Class:
Ordinary physical activity causes symptoms
2
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.
False. Pts can be reclassified depending on symptoms in the NYHAF classification.
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.
True
(Left/right) sided heart failure presents with pulmonary crackles most prominent at (base/apex) posteriorly.
Left
base
(Left/right) sided heart failure presents with dependent edema.
Right
Hepatojuguar reflux sign (HJR) is used to assess for _____
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.
Left sided heart failure presents with ____ upon auscultation.
apical S3 gallop
T/F: Heart failure presents with widened pulse pressure and tachycardia at rest.
False. Narrowed pulse pressure
Left sided elevated filling pressures cause _____
dyspnea
Pro-BNP/BNP > 500 pg/ml suggests ____
heart failure as cause of dyspnea
BUT NOT specific for cardiac etiology of dyspnea
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
C. Decreased contractility in systolic dysfunction
Decreased compliance in diastolic dysfunction
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
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.
Valve insufficiency and shunts cause what mechanical cause of heart failure?
Volume overload
Valve stenosis and HTN cause what mechanical cause of heart failure?
Pressure overload
Constrictive pericarditis is a ____ cause of heart failure characterized by (acute/chronic) presentation w/ _____
Pericardial
chronic
peripheral edema, ascites
Cardiac tamponade is a ____ cause of heart failure characterized by (acute/chronic) presentation w/ ____
Pericardial
acute
hypotension
Which of the following is NOT a treatment of acute non-hypotensive pulmonary edema? A. Morphine IV B. Furosemide IV C. Vasoconstrictors D. Oxygen
C. Vasodilators for pulmonary edema w/ systemic arterial HTN
Name the stage of heart failure:
Structural heart disease w/ prior or current symptoms of HF
C
Name the stage of heart failure:
High risk of HF w/o structural heart disease or symptoms of HF
A
Name the stage of heart failure:
Refractory HF requiring specialized interventions
D
Name the stage of heart failure:
Structural heart diseae w/o signs/symptoms of HF
B
Ex: previous MI
Ex: Left ventricular hypertrophy secondary to HTN or valve disease/asymptomatic valve disease
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
B. Except amidarone, dofetilide
C. Except vasoselective ones
D. Except low dose aspirin
Name the short acting ACE-I
Captopril:
ACE-I or ARB used if ____
decreased left ventricular ejection fraction
T/F: If problem w/ orthostatic hypotension or rising BUN, you should consider decreasing ACE-I before decreasing diuretics
False. Vice versa
Which of the following is a side effect of ACE-I? A. Orthostatic hypertension B. Hypokalemia C. Decreased BUN/Creatinine D. Angioedema
D
A. Orthostatic hypotension
B. Hyperkalemia
C, Increased BUN/creatinine due to volume deletion
T/F: Unilateral renal artery stenosis is contraindicated for ACE-I
False. Bilateral
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
C. Improves symptoms, does NOT prolong survival
Treat with ____ if PH of MI or decrease LVEF.
Beta-adrenergic blockers
Carvedilol: non-selective
Metoprolol: beta-1 selective
Aldosterone antagonists (spironolactone, eplerenone) is contraindicated for ____ (2)
Severe renal insufficiency
Baseline hyperkalemia
If LVEF less than 30-35%, consider treatment w/ ____
Inplantable cardioverter-defibrillator (ICD)
If LVEF less than 35% & wide QRS duration, consider treatment w/ ____
Biventricular pacing = cardiac resychronization therapy
Consider treatment with ____ if pt has left ventricular systolic dysfunction who remain symptomatic dispite therapy w/ diuretics, ACE-Is and beta blockers.
Digoxin
