252 HF Patho

Question 1

In industrialized countries, predominant causs and responsible for 60-70% of heart failure

Answer 1

CAD

Question 2

Major cause if HF in Africa and Asia

Answer 2

Rheumatic heart disease

Question 3

NYHA classification: marked limitation of physic activity. Fatigue, dyspnea on less than ordinary activity

Answer 3

Class III

Question 4

Refers to changes in LV mass, volume, and shape and the composition of the heart that occur after cardiac injury

Answer 4

Ventricular remodeling

Question 5

Most common symptom of cor pulmonale

Answer 5

Dyspnea

Question 6

Pleural effusion. Ascites. Edema. What’s the diagnosis?

Answer 6

Emphysema with cor pulmonale

Question 7

complex clinical
syndrome that results from structural or functional impairment of
ventricular filling or ejection of blood, which in turn leads to the
cardinal clinical symptoms of dyspnea and fatigue

Answer 7

Heart failure

Question 8

True or false. approximately one-half of patients who develop HF have a normal or preserved EF (EF ≥50%).

Answer 8

True.

Question 9

considered as having a borderline or mid-range EF

Answer 9

Patients with a LV EF between 40 and 50%

Question 10

responsible for 60–75% of cases of HF in industrialized countries

Answer 10

coronary artery disease (CAD

Question 11

remains a major cause of HF in Africa and Asia, especially in the young.

Answer 11

Rheumatic heart disease

Question 12

still a major cause of HF in South America

Answer 12

Chagas’ disease

Question 13

True or false. Despite recent advances in the management of HF, the development of symptomatic HF still carries a poor prognosis

Answer 13

True.

Question 14

NYHA class. Patients with cardiac disease but without resulting limitation of physical activity

Answer 14

Class I

Question 15

NYHA class. Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at res

Answer 15

Class II

Question 16

NYHA class. Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest

Answer 16

Class III

Question 17

NYHA class. Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort.

Answer 17

Class IV

Question 18

reasons why patients with LV dysfunction may remain asymptomatic

Answer 18

(1) activation of the renin-angiotensin-aldosterone system (RAAS) and the adrenergic nervous system (2) increased myocardial contractility

Question 19

series of adaptive changes within the myocardium collectively referred to as

Answer 19

LV re modelling

Question 20

The cardinal symptoms of HF

Answer 20

fatigue and shortness of breath

Question 21

Important mechanism of dyspnea in HF

Answer 21

pulmonary congestion with accumulation of interstitial or intra-alveolar fluid, which activates juxtacapillary J receptors, which in turn stimulate the rapid, shallow breathing characteristic of cardiac dyspnea.

Question 22

True or false Dyspnea may become less frequent with the onset of right ventricular
(RV) failure and tricuspid regurgitation.

Answer 22

True.

Question 23

defined as dyspnea occurring in the recumbent position

Answer 23

Orthopnea

Question 24

True or false. Orthopnea is usually a later manifestation of HF than is exertional dyspnea

Answer 24

True.

Question 25

Common manifestation of orthopnea

Answer 25

Nocturnal cough

Question 26

refers to acute episodes of severe shortness of breath and coughing that generally occur at night and awaken the patient from sleep

Answer 26

Paroxysmal nocturnal dyspnea

Question 27

When does paroxysmal nocturnal dyspnea occur

Answer 27

usually 1–3 h after the patient retires

Question 28

True or false Cheyne-Stokes respiration is present in 40% of patients with advanced HF and usually is associated with low cardiac output

Answer 28

True.

Question 29

referred to as periodic respiration or cyclic respiration

Answer 29

Cheyne-Stokes respiration

Question 30

a nonspecific sign caused by increased adrenergic activity

Answer 30

Sinus tachycardia

Question 31

Examination of the jugular veins provides an estimation of

Answer 31

right atrial pressure

Question 32

The jugular venous pressure is best appreciated with the patient lying recumbent, with

Answer 32

head tilted at 45°.

Question 33

Normal jugular venous pressure

Answer 33

normal ≤8 cm

Question 34

True or false pleural effusions occur most commonly with biventricular failure.

Answer 34

True.

Question 35

Although pleural effusions are often bilateral in HF, when they are unilateral, they occur more frequently in

Answer 35

the right pleural space.

Question 36

Cardiac examination most commonly present in patients with volume overload who have tachycardia and tachypnea, and it often signifies severe hemodynamic compromise.

Answer 36

An S3 (or protodiastolic gallop)

Question 37

The most useful index of LV function

Answer 37

EF (stroke volume divided by end diastolic volume)

Question 38

released from the failing heart, are relatively sensitive markers for the presence of HF with depressed EF

Answer 38

Both B-type natriuretic peptide (BNP) and N terminal pro-BNP (NT-proBNP)

Question 39

Peak oxygen uptake associated with a relatively poor prognosis.

Answer 39

peak oxygen uptake (vo2) <14 mL/kg per min is associated with a relatively poor prognosis.

Question 40

cardinal manifestation of HF

Answer 40

Peripheral edema

Question 41

referred to as pulmonary heart disease, is broadly defined by altered RV structure and/or function in the context of chronic lung disease and is triggered by the presence of pulmonary hypertension.

Answer 41

Cor pulmonale

Question 42

an important sequela of HFpEF and HFrEF

Answer 42

RV dysfunction

Question 43

True or false Although RV dysfunction is an important sequela of HFpEF and HFrEF, this is not considered as cor pulmonale.

Answer 43

True.

Question 44

Common pathophysiologic mechanism in cor pulmonale

Answer 44

pulmonary hypertension and increased RV afterload sufficient to alter RV structure

Question 45

mean pulmonary artery pressure

Answer 45

only ~15 mmHg

Question 46

True or false Anatomically, the RV is a thin-walled, compliant chamber better suited to handle volume overload than pressure overload

Answer 46

True.

Question 47

True or false. Cyanosis is a late finding in cor pulmonale

Answer 47

True.

Question 48

The ECG in severe pulmonary hypertension shows

Answer 48

P pulmonale, right axis deviation, and RV hypertrophy

Question 49

True or false BNP and N-terminal BNP levels are elevated in patients with cor pulmonale secondary to RV myocardial stretch

Answer 49

True.

Question 50

remains best suited for diagnosing chronic thromboembolic disease

Answer 50

ventilation-perfusion scan