0201 Heart Failure

Question 1

LV Remodeling contributes to HF by ____

Answer 1

by the mechanical changes that happen to the wall (thinning that leads to increased aftrerload). Afterload mismatch

Question 2

What are the goals of treating HF

Answer 2

Prevent/reverse remodeling

Question 3

dyspnea caused by HF is multifactorial, most important mechanism is

Answer 3

Pulmonary congestion (accumulation of interstitial fluid)

Question 4

orthopnea is a specific symptom of HF (T/F)

Answer 4

True

Question 5

how to measure JVP? what is normal value?

Answer 5

45 degrees recumbent patient, measure water column from the sterna angle. Normal <8 cm

Question 6

Chronic HF patients present with rales(T/F)

Answer 6

False, generally the lymphatic system adapts

Question 7

what causes pleural effusion?

Answer 7

elevation of pleural capillary pressure–> transudation of fluid

Question 8

the most useful index of LV function is ____

Answer 8

Ejection Fraction

Question 9

the most useful index of LV function is ____

Answer 9

Ejection Fraction

Question 10

What biochemical test can support HF in ambulatory patients

Answer 10

BNP nad NT-ProBNP

Question 11

in HF patients Exercise testing is used to____

Answer 11

evaluate candidacy for Heart transplant

Question 12

in HF patients Exercise testing is used to____

Answer 12

evaluate candidacy for Heart transplant

Question 13

What is Cor Pulmonale

Answer 13

…

Question 14

most common causes of Cor pulmonate in North America

Answer 14

COPD nad Chronic bronchitis (50% of For pulmonate patients)

Question 15

What is the difference between pure right HF and Cor pulmonale

Answer 15

in both cases right HF

the etiology in Cor Pulmonale is Pulmonary

Question 16

Most common symptom of Cor Pulmonale is___

Answer 16

dyspnea

Question 17

Cor Pulmonale: Auscultation

Answer 17

S3 Gallop. RV heave on the left sternal border

Question 18

What is P pulmonale (ECG)

Answer 18

Sharp P wave in inferior leads (2,3,aVF)

Question 19

What is P pulmonale (ECG)

Answer 19

Sharp P wave in inferior leads (2,3,aVF

Question 20

what are the targets for treating HFpEF?

Answer 20

Control congestion,

stabilize of heart rate and blood pressure

improve exercise tolerance

Question 21

Typical ADHF management principals

Answer 21

if Hypertensive: Vasiodialators

if Nomotensive: Diuretics

Question 22

In ADHF patients when should you use pulmonary catheters:
A. Always
B. High BUN
C. Low Cardiac output, 
D. Poor response do diuresis

Answer 22

C+D

Low cardiac output signs I=(Hypotension), or poor response to diuresis

Question 23

When is IV administration of Diuretics recommended in ADHF patients?

Answer 23

when there is impaired response to oral treatment:

requiring very high doses of oral diuretics.

or subotimal effect of diuresis

Question 24

When treatingg ADHF when is metolazone recommended?

Answer 24

patients receiving longterm therapy with loop diuretics

Question 25

How do you decide on discharging ADHF?

Answer 25

Physcial examination (normal JVP) coupled with positive trends in biomarkers

Question 26

the problem with long-term inotropic treatment in ADHF is ___

Answer 26

increased mortality

Question 27

When should Dobutamine and milrinone be give in the context of ADHF

Answer 27

in hospitalized patients with documented systolic dysfunction, short-term and a s bridge therapy for patients awaiting transplant

Question 28

When is milrinone proffered over dobutamine

Answer 28

milrinone acts downstream to the Beta1-adrenergic receptor and thus can be given to patients on beta blockers

Question 29

Increasing ACEi dosage in HFrEF improves survival (T/F)

Answer 29

False

Question 30

Increasing B-Blocker dosage in HFrEF patients improves survival (T/F)

Answer 30

True

Question 31

HFrEF: Mineralocorticoids

Answer 31

Aldosterone antagonists reduce mortality in NYHA II to IV. Reduction in Suddden Cardiac Death.

Question 32

HFrEF: Mineralocorticoids (side effects)

Answer 32

Hyperkalemia. Beware in CKD, and Renal Failure patients

Question 33

Angiotensin levels can return normal after ACEi treatment in hFrEF patients (T/F)

Answer 33

True | Callede Neurohormonal escape

Question 34

How do you deal with neurohormonal escape in HFrEF patients receiving B-Blockers and ACE-i

Answer 34

switch to ACEi and ARB.

Question 35

The initial clinical strategy in HFrEF patients is _(x)_-drug combination...

Answer 35

Thus, the initial clinical strategy should be to use a two-drug combination first (ACEI and beta blocker; if beta blocker intolerant, then ACEI and ARB; if ACEI intolerant, then ARB and beta blocker). In symptomatic patients (NYHA class II–IV), an aldosterone antagonist should be strongly considered, but four-drug therapy should be avoided.