Heart Failure (Exam IV)

Question 1

What ejection fraction would characterized HFrEF (heart failure with reduced ejection fraction) ?

Answer 1

≤ 40%

Question 2

What ejection fraction would characterized HFpEF (heart failure with preserved ejection fraction) ?

Answer 2

≥ 50%

Question 3

Which type of heart failure is characterized by reduced compliance and restricted left ventricular filling?

Answer 3

LV Diastolic Failure

Question 4

Which type of heart failure is characterized by reduced contractility, LV dilation, pulmonary congestion, and increased ESV and EDV volumes?

Answer 4

LV Systolic Failure

Question 5

Systolic dysfunction results in _______ ventricular systolic wall motion.

Answer 5

decreased

Question 6

What are the four common causes of systolic heart failure?

Answer 6

• CAD
• Dilated Cardiomyopathy
• Chronic ↑ Afterload (HTN, AS, etc)
• Chronic Volume overload

Question 7

What is the hallmark sign of Chronic LV systolic dysfunction?

Answer 7

EF ≤ 40%

Question 8

What are common causes of Diastolic Heart Failure?

Answer 8

• CAD
• Chronic HTN
• Chronic AS

Question 9

Is systolic or diastolic heart failure age-dependent?

Answer 9

Diastolic HF

Question 10

Which class of diastolic HF is characterized by abnormal LV relaxation but normal left atrial pressures?

Answer 10

Class I

Question 11

Diastolic HF classes II, III, and IV are characterized by what?

Answer 11

• Abnormal relaxation
• ↓ LV compliance
• ↑ LVEDP

Question 12

What is acute decompensated HF?

Answer 12

Chronic HF that has developed to become Acute

Question 13

What is de novo acute HF?

Answer 13

Sudden myocardial dysfunction (ex. MI)

Emergency.

Question 14

Chronic heart failure features venous ________, but the BP is _________.

Answer 14

congestion; normal

Question 15

Stroke volume is directly related to ________.

Answer 15

LVEDP

Question 16

What normal physiologic mechanism contributes to the continued deterioration of chronic HF?

Answer 16

SNS activation

Question 17

Why does the RAA system get activated in chronic heart failure?

Answer 17

RAAS activated due to decreased renal blood flow

Question 18

Define afterload.

Answer 18

Pressure needed to open the semi-lunar valves.

Question 19

Will tachycardia increase or decrease CO in a patient with diastolic HF?

Answer 19

Decrease CO

Question 20

What is the endocrine response of the heart to chronic HF ?

Answer 20

• ↑ ANP secretion from the atria
• ↑ BNP secretion from the ventricles

Question 21

What are the physiologic effects of the natriuretic peptides?

Answer 21

• Diuresis
• Natriuresis
• Vasodilation
• Anti-inflammatory
• RAAS & SNS inhibition

Question 22

ANP and BNP secretion inhibit what two things?

Answer 22

• Hypertrophy
• Fibrosis

Question 23

What type of hypertrophy is noted by 1 on the figure below?

Answer 23

Concentric Hypertrophy

Question 24

What type of hypertrophy is noted by 2 on the figure below?

Answer 24

Eccentric Hypertrophy

Question 25

What auscultated sound is indicative of heart failure?

Answer 25

S3 gallop

Question 26

What are kerley lines on a chest x-ray ?

Answer 26

Linear opacities caused by interstitial pulmonary edema

Question 27

What lab value is 90% predictive of a HF diagnosis?

Answer 27

BNP > 500 pg/mL

Question 28

Describe the NYHA heart failure classification scale.

Answer 28

Question 29

Describe the 2005 ACC/AHA heart failure classification scale.

Answer 29

Question 30

What is the Intermacs profile system?

Answer 30

Question 31

What drug classes are preferred for treatment of HFrEF ?

Answer 31

• β-blockers
• ACE-Inhibitors

Question 32

What drug class is useful for the control of hypertension and HFpEF?

Answer 32

ARBs

Question 33

Statins are not recommended in HFrEF patients. T/F?

Answer 33

False. Statin are recommended in all HF patients

Question 34

When is cardiac resynchronization therapy indicated?

Answer 34

• NYHA class III or IV
• LVEF < 35%
• QRS duration of 120-150 ms