Week 9 formative quiz questions Flashcards
Warfarin may be useful in the management of heart failure.
True - Thrombus can form in the dilated ventricle which has the potential to embolise. Warfarin can be used to prevent thrombus formation.
A 60 year old patient presents to their GP with a 3 month history of breathlessness which is worse on exertion and on lying down. They describe having to use four pillows at night to get to sleep and have noticed swelling around their ankles. They are a smoker and last year suffered a STEMI. The likely diagnosis is COPD.
False – although COPD is a possible cause of breathlessness in a smoker, the history is much more typical of orthopnoea, which is seen in heart failure. The STEMI last year would also make heart failure more likely.
In normal micro-circulation movement of fluid through capillaries is driven by hydrostatic pressures and oncotic pressures.
True – in health, these forces are balanced so there is no abnormal accumulation of fluid.
Echocardiogram is a useful investigation in heart failure.
True - It may be used to look at the structure of the heart and assess for potential causes.
High potassium levels increase the risk of Digoxin toxicity.
False - LOW potassium levels increase the risk of Digoxin toxicity.
Bleeding from oesophageal varices can be fatal.
True – these bleeds (caused by rupture of congested oesophageal veins due to raised hepatic portal pressure) can be brisk and tricky to stop, and can sometimes be fatal.
The most appropriate management of heart failure is transplantation.
Medical therapy is first line with an aim to improve symptoms AND improve survival.
A potential side effect of Amiodarone is pulmonary fibrosis.
True - Others include slate grey skin, hyper/hypothyroidism and corneal deposits
A patient is started on a new medication for heart failure. They are now complaining of a dry cough. This new medication is likely to be an ACE inhibitor.
True - A dry cough is a common side effect of ACE inhibitors.
Low levels of protein in serum leads to a high capillary oncotic pressure.
False - Low protein levels in serum, for example low albumin levels, will cause a low capillary oncotic pressure. There will therefore be poor fluid retention/re-absorption, leading to oedema.
Hepatic cirrhosis can lead to congestion in the portal system.
True - Changes in liver architecture leads to altered hepatic blood flow. Back pressure leads to increased portal venous pressure.
Calcium channel blockers can be used for rate control in atrial fibrillation.
True – examples include verapamil and diltiazem.
Pericardial disease can cause heart failure.
True – particularly constrictive pericardial disease, where scarring of the pericardium limits the contractility of the heart.
Adenosine is often used to convert ventricular tachycardia to sinus rhythm.
False - Adenosine is often used to convert supraventricular tachycardia to sinus rhythm due to its effect of slowing conduction through the AV node.
In systolic dysfunction, cardiac output is usually increased.
False - in systolic dysfunction, cardiac output is reduced, usually due to reduced stroke volume. Heart rate is often increased to attempt to compensate for this (remember that CO = HR x SV)
The Renin-angiotensin-aldosterone system is activated in heart failure. Its end-result is fluid loss and vasodilatation.
False - There is inadequate kidney perfusion in heart failure leading to the activation of the RAAS system, causing fluid retention. Angiotensin II is a potent vasoconstrictor NOT vasodilator.
Warfarin inhibits the production of vitamin K dependant clotting factors.
True - These factors include factor II, VII, IX, and X. It is therefore reversed by giving vitamin K.
Amiodarone is used in the treatment of ventricular tachycardia.
True – This is one of the drugs used in the Advanced Life Support algorithm for cardiac arrest, including VT arrest.
Caput medusae is a potential consequence of congestion in the portal venous system.
True - Back pressure, for example in liver cirrhosis, leads to venous congestion in the portal system. There is distension at sites of anastomosis with systemic circulation for example caput medusae seen in the abdomen and oesophageal varices. “Caput Medusae” means “head of Medusa” and refers to the snake-like extension of these congested veins outwards from the umbilicus.
Loop diuretics are used in the management of heart failure
Loop diuretics are the mainstay of symptomatic therapy. These act to inhibit Na-K-Cl transporters in the Loop of Henle and therefore reduce the fluid overload by inducing diuresis.
In Mobitz type I (2nd degree heart block) there is progressive PR prolongation until a p wave fails to conduct to the ventricle.
True - This is also known as the Wenckebach phenomenon.
Fluid mainly accumulates in the periphery in left heart failure.
False - Fluid accumulates in the lungs in left heart failure leading to pulmonary oedema.
Warfarin may be used in the management of atrial fibrillation.
True - Anticoagulation is necessary in atrial fibrillation, especially chronic atrial fibrillation, due to the risk of a thrombus forming and subsequent risk of embolization. Be aware that there are several alternatives to Warfarin that are also widely used.
Congestion is excess blood in vessels, tissues or an organ.
True – Correct. This is usually due to a slowing or disruption of drainage.
