Heart Failure (Light-McGroary)

Question 1

what is the most common cause of right sided heart failure?

Answer 1

left heart failure

Question 2

common causes of this type of heart failure include ischemia, mitral/aortic valve disease, and restrictive cardiomyopathies

Answer 2

left sided heart failure

Question 3

this type of heart failure has a higher incidence in older patients, diabetics, and women

Answer 3

diastolic heart failure

Question 4

this type of heart failiure is often due to ischemic heart disease, hypertension, or “idiopathic”

Answer 4

systolic heart failure

Question 5

____ cor pulmonae is due to events such as pulmonary embolism and result in the dilation of the heart, capable of causing sudden cardiac death

Answer 5

acute

Question 6

____ cor pulmonae is due to right A/V dilation and hypertrophy and is often preceded by the development of arterial plaques and lesions

Answer 6

chronic

Question 7

the amount of stretch on the ventricle after diastole, estimated by end diastolic pressure

Answer 7

preload

Question 8

the load against which the heart must contract; reflects the compliance of the large arteries

Answer 8

afterload

Question 9

All of the following are symptoms of right-sided heart failure EXCEPT:

A. Weight loss
B. Anorexia
C. Orthopnea
D. Abdominal bloating
E. Hiccups

Answer 9

C. Orthopena is a sign of left sided heart failure, along with dyspnea on exertion, nocturnal coughing/awakening, palpitations, hemoptysis (coughing up blood) and nocturia.

Question 10

All of the following are signs of left-sided heart failure EXCEPT:

A. Hypotension
B. Hepatomegaly
C. Rales and gallop
D. Pleural effusion
E. Cool extremities

Answer 10

B. Hepatomegaly is a sign of right sided heart failure, along with ascites, elevated JVP, sternal lift, and peripheral edema. (More venous congestion symptoms)

Question 11

True or false: when the heart responds to stress, it is capable of cell division, increasing its number of myocytes to respond to that stress.

Answer 11

False. A cell cannot increase its number of myocytes, they can only hypertrophy to increase the size of the existing myocytes and the number of sarcomeres.

Question 12

what are the two diseases characteristic of a pressure overload state (increased afterload), in which new sarcomeres are being added in parallel to the long access of the myoctyes causing concentric hypertrophy?

Answer 12

HTN and valvular stenosis

Question 13

what are the two diseases characteristic of a volume overload state (increased preload), in which new sarcomeres are added in series, adding to muscle fiber length and leading to ventricular dilation and hypertrophy?

Answer 13

valvular regurgitation and shunts

Question 14

_____ hypertrophy is associated with diastolic heart failure and is characterized by increased wall thickness and decreased chamber size

Answer 14

pressure

Question 15

_____ hypertrophy is associated with systolic heart failure and is characterized by static (or decreased) wall thickness and a dilated chamber.

Answer 15

volume

Question 16

why are liver pathology findings associated with left ventricular failure?

Answer 16

the liver takes a large portion of the cardiac output, pumped from the left ventricle into stystemic circulation.

Question 17

True or false: a person with stage B heart failure may be asymptomatic but has signs of heart failure on an EKG.

Answer 17

True.
Stage A = people at risk for developing HF
Stage B = asymptomatic with some marker for HF (previous MI, LV systolic dysfunction)
Stage C = symptomatic
Stage D = marked symptoms at rest, heavily impaired, resistant to medication

Question 18

what is the only treatment we have developed for diastolic heart failure?

Answer 18

diuretics to decrease fluid load, and work to treat the underlying problem. most pharmacology is aimed at systolic heart failure.

Question 19

how are beta blockers effective in treating heart failure?

Answer 19

they block the sympathetic response, reverse cardiac remodeling, and improve the ejection fraction

Question 20

which beta blockers are approved for treating heart failure?

Answer 20

carvedilol, metoprolol succinate (long-acting), bisoprolol

Question 21

this diuretic is commonly used in combination therapy for treatment of heart failure, because of its anti-fibrotic and potassium sparing effects

Answer 21

spironolactone

Question 22

a major side effect of spironolactone that can be addressed by switching to the more aldosterone selective eplerenone

Answer 22

gynecomastia

Question 23

what is a good medication option for reduction of afterload in patients who are intolerant of ACE inhibitors and ARBs?

Answer 23

vasodilators (ie, hydralazine), often combined with nitrates. this treatment combination seems to work better than ACEIs and ARBs in the african american population.

Question 24

class of drugs MOST used in treatment of heart failure

Answer 24

loop diuretics

Question 25

though this drug has been shown to reduce hospitalization, it does not reduce morbidity and is not often used due to narrow therapeutic ratio and its positive ionotropic effect

Answer 25

digoxin

Question 26

types of drugs used most effectively for acutely decompensated HF patients or bridging patients to the next step of treatment (heart transplant)

Answer 26

inotropes

Question 27

what is the best treatment for a patient who displays the most common presentation of heart failure, “warm and wet”, in terms of congestion and perfusion?

Answer 27

diuretics and vasodilators - main treatment goal is to get the excess fluid off the patient