Teach heart Failure

Question 1

Most common cause of HF

Answer 1

Coronary artery disease

Question 2

Etiologies of heart failure per EF

Answer 2

Depressed EF <40
CAD
HTN 
Valvular disease
Dilated C 
Toxic CM
For pulmonary

Preserved EF>40-50%
Aging
Primary hypertroohy
Restrictive CM
Fibrosis

High output states
BAHA
Beriberi anemia hyperthyroid AV fistula

Question 3

Pathophysio heart failure

Answer 3

Barorecepyors
Increased sympathetic
Increase renin –> AT2
Increase vasopressin

Dec RBF
Inc aldosterone
In water and Na reabsorption

Question 4

Cardinal s and s of HF

Answer 4

Fatigue

Shortness of breath

Question 5

Most impressive mech for dyspnea

Answer 5

Pulmo congestion accumulation of interstitial fluid

Junta capillary J receptors

Question 6

Define orthopnea

What is pathophy

Answer 6

Dyspnea in recumbent position
Redistribution of fluid from splanchnic circ and lower extremities to central circ resulting in inc Pulmo capillary pressure

Question 7

Define PND

Answer 7

Sob and coughing at night
1-3 h after patient retires

Diff from orthopnea: no relief sitting upright

Question 8

Abdominojugular reflex

Answer 8

15 sec sustained in inc JVP 3 dm water

Question 9

JVP exam of HF

Answer 9

Giant v waves due to tricuspid regurgitation

Question 10

Pathophy s3 in HF

Answer 10

Volume overload

Question 11

Dx in HF

Answer 11

ECG
Car
2d echo
ProBNP

Question 12

Novel biomarkers in HF

Answer 12

ST2

Galectin 3

Question 13

What is cor pulmonale

Answer 13

Altered Arab structure and/or function in the context of chronic lung disease

Question 14

S/s in cor pulmonale

Answer 14

Dyspnea

Question 15

PE in cor pulmonale

EXG findings

Answer 15

Carvallo’s sign of TR

ECG:

• p pulmonale
• RAD
• RV hypertroohy

Question 16

MC cause of RHF

Answer 16

L HF

Question 17

SENIORS study

Answer 17

Nebivolol on elderly has no benefit in all cause mortality

Question 18

TOPCAT

Answer 18

Aldosterone antagonist therapy

Question 19

Calcium sensitized thanprovide inotropic activity

Answer 19

Levosimendan

Question 20

Selective myosin activator prolongs EF

Answer 20

Omecamtiv mecarbil

Question 21

The only beta blockers with positive outcomes in HF

Answer 21

Carvedilol
Bisoprolol
Metoprolol

Question 22

Changes that occur in the cross bridges in HF

Answer 22

Decreased expression: alpha myosin heavy chain

Increased expression: beta myosin heavy chain

Question 23

What is afterload mismatch

Answer 23

Increase in wall thinning to match the increase in afterload created by LV dilation leads to functional afterload mismatch

Question 24

What is cheyne stoke respiration associated with?

Answer 24

Low cardiac output

Mechanism: increased sensitivity of the respiratory center to arterial pco2

Apneic phase po2 falls pco2 rises

Question 25

Hold standard for assessingLv mass and volumes

Answer 25

MRI

Question 26

Cardiac exam diastolic dysfunction

Answer 26

S4

Question 27

Role of threadmill or bicycle exercise testing

Answer 27

Transplant in peak oxygen uptake <14 ml/kg

Question 28

False negative pro BNP

Answer 28

Obese patients

Question 29

False positive BNP

Answer 29

Renal impairment
Age
Women more elevated
Right sided HF from any cause

Question 30

New biomarkers HF

Answer 30

ST3

Galectin

Question 31

Prominent v waves in for pulmonale

Answer 31

Tricuspid regurgitation

Question 32

Useful in diagnosis of a

1) acute thromboembolic disease
2) chronic thromboembolic disease
3) ILD

Answer 32

1 spiral CT
2 vQ scan
3 hrct

Question 33

Trials in heart failure

CHARM

Answer 33

Candesartan in Heart Failure—Assessment of Mortality and Morbidity (CHARM) Preserved study showed a statistically significant reduction in hospitalizations but no difference in all-cause mortality in patients with HFpEF who were treated with the angiotensin receptor blocker (ARB), candesartan

Question 34

Trials in heart failure

I-PRESERVE

Answer 34

Irbesartan in Heart Failure with Preserved Systolic Function (I-PRESERVE) trial demonstrated no differences in meaningful endpoints in such patients treated with irbesartan

Question 35

DIG trials

Answer 35

Digitalis Investigation Group (DIG) trial found no role for digoxin in the treatment of HFpEF

Question 36

Trial: SENIORS

Answer 36

Study of the Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors with Heart Failure (SENIORS) trial of nebivolol, a vasodilating beta blocker, the subgroup of elderly patients with prior hospitalization and HFpEF did not appear to benefit in terms of all-cause or cardiovascular mortality

Question 37

Evidence neurohormonal antagonism in heart failur epatients

Answer 37

Meta-analyses suggest a 23% reduction in mortality and a 35% reduction in the combination endpoint of mortality and hospitalizations for heart failure in patients treated with ACEIs. Patients treated with beta blockers provide a further 35% reduction in mortality on top of the benefit provided by ACEIs alone.

Question 38

Associated with reduction in mortality in all stages in symptomatic NYHA VLASS II to IV HFrEF

Answer 38

Mineralocorticoid antagonist spirinolactone and eplerenone

Question 39

Recommendations for ivabradine inpatients with HFrEF

Answer 39

ivabradine was suggested as second-line therapy before digoxin is considered in patients who remain symptomatic after guideline-based ACEIs, beta blockers, and mineralocorticoid receptor antagonists and with residual heart rate >70 beats/min.