Trigger - HF 1

Question 1

RUQ pain, SOB, Orthopnea, and PND are symptoms of what

Answer 1

ACUTE heart failure

Question 2

Edema, Anorexia, Abdominal distention and fatigue are common symptoms of what

Answer 2

CHRONIC heart failure

Question 3

can be caused by thyrotoxicosis, severe anemia and sepsis

Answer 3

high output HF

Question 4

what type of HF is EF of 46%

Answer 4

Type a - HFpEF borderline

Type I - HFrEF (EF </=40%)
Type II - HFpEF (EF >/= 50%)
Type a - HFpEF, borderline (EF 41-49%)
Type b - HFpEF, improved (EF >40%)

Question 5

JVD, hepatic congestion, ascites, LE edema

Answer 5

R sided HF s/s

Question 6

when do you see isolated R sided HF

Answer 6

rare, only when lung disorder is present!

Question 7

DOE, PND, Orthopnea, fatigue, cyanosis

Answer 7

Left sided HF

Question 8

These classes quantify functionality

Answer 8

NYHA

Question 9

These classes CANNOT change and describe the evolution of HF

Answer 9

ACC/AHA

Question 10

How would you classify someone with structural HF that has symptoms occasionally

AHA classification

Answer 10

Class C

A = At risk but no disease or symptoms.
B = Structural disease but no S/S.
C = Structural dsease with prior or current S/S
D = Refractory HF that requires specialized interventions (Usually class IV patients)

Question 11

what causes RAAS system activation in HF

Answer 11

poor renal perfusion d/t poor CO.

leads to fluid retention and sodium dilution -> hyponatremia

Question 12

increases ventricular contractility of the heart and HR.

also leads to vasoconstriction and enhanced venous tone, increasing preload

Answer 12

NE release. (d/t activation of SNS)

Question 13

how does plasma concentration of NE correlate with HF severity

Answer 13

inversely correlated

Question 14

kidney rxn to HF

Answer 14

Increased proximal tubular sodium reabsorption, which contributes to sodium retention in HF.

Question 15

stimulated by increased beta - q adrenergic activity

Answer 15

RAAS system

also stimulated by decreased glomerular filtration

Question 16

this peptide rises in early HF

Answer 16

ANP

Question 17

this is released in response to high ventricular filling pressures

Answer 17

BNP

Question 18

this Reduces SVR and central venous pressure and increases natriuresis to reduce afterload.

Answer 18

BNP

Question 19

effects of angiotensin II and catecholamines

Answer 19

promote myocyte loss and result in cardiac remodeling

Question 20

venous return and EDV (end-diastolic volume) is considered what

Answer 20

preload

Question 21

force generated at any given EDV

Answer 21

contractility

Question 22

aortic impedance, SVR, and wall stress

Answer 22

Afterload

Question 23

4 common PE findings in HF

Answer 23

Resting sinus tach
narrow PP (< 25 mm Hg)
Diaphoresis
Peripheral vasoconstriction

Question 24

What causes myocytes to develope more AT receptors and therefore result in apoptosis

Answer 24

RAAS system

Question 25

if a patient has edema with a 4 mm depression that resolves in 10 seconds what is her classification

Answer 25

2+ moderate pitting edema

1. mild pitting (2mm depression)
2. moderate pitting (4mm depression that disapears in 10-15s)
3. moderate/severe - (6mm depression that last >1 min)
4. severe - (8mm depression lasting >2 min)

Question 26

what does pulsus alternans suggest

Answer 26

Pathognomonic finding in severe LV failrue

Question 27

what does a laterally discplaced apical impulse suggest

Answer 27

LV enlargement

Question 28

what does parasternal lift of RV on precordial palpation suggest

Answer 28

pulmonary HTN

Question 29

is S4 associated with systolic or diastolic HF

Answer 29

diastolic

S3 - systolic
S4 - diastolic

Question 30

4 HF findings in CXR

Answer 30

Pulmonary vascular congestion
KERLEY B lines
cardiomegaly
Pleural effusions

Question 31

released in response to atrial volume expansion

Answer 31

ANP

Question 32

what is the BEST test for HF evaluation

Answer 32

BNP and NT-ProBNP

Question 33

when do we do stress testing in HFrEF

Answer 33

R/o CAD

Question 34

donnneeee

Answer 34