Congestive Heart Failure

Question 1

Peripartum Cardiomyopathy risks:

Answer 1

age > 30
multiparity
African descent
hx of eclampsia, preeclampsia, post partum htn
maternal cocaine use, > 4 wks tocolytic rx with b agonists

Question 2

Peripartum Cardiomyopathy treatment:

Answer 2

optimize hemo
avoid ace
hydralazine drug of choice
anticoagulate

Question 3

HIV cardiomyopathy:

Answer 3

not receiving HAART, 17% incidence in Rowanda
cmv in late stages- also direct hiv, coxsackie and ebv
30% reduction in hiv cm with HAART rx

Question 4

etoh cardiomyopathy

Answer 4

80-90 gm etoh/d
1 liter wine, 8 beers/d 1/2 pt liquor
less fibrosis, better prognosis

Question 5

Hemochromotosis

Answer 5

MRI T2
dm, arthritis, hyperpigmented
thalassemia transfusion
treat phlebotomy, chelation

Question 6

Antracycline induced CM:

Answer 6

dose > 550 mg/m2 higher incidence than < 1 yr after exposure, but up to 10 yrs
associated with radiation, dm, htn, poor nutrition
attenuate/ prevent with ace, carvedilol, dexrazoxane

Question 7

MM dystrophies, cardiomyopathies

types

Answer 7

Duchenne’s (dystrophin absent) myopathy more severe

beckers - abnormal dystrophin so myopathy less, but cardiomyopathy worse
dystrophin- in sarcolemmal membrane

Question 8

Stress Cardiomyopathy
chf incidence
rx
recurrence

Answer 8

Takotsubo
post menopausal women
16% chf, pul edema- card shock 10%, trigger emotional stress
rx supportive- anticoag, ace, b blocker
recurrence <4% mortality 1.7% in hospital

Question 9

Hypertrophic CM rx

Answer 9

avoid vol depletion
activity limit
avoid ionotropes, sauna, etoh
rx b blocker, or verap/dilt/ disopyramide, myectomy
ICD: arrest, sustained vt/vf (consider if fhx, >30mm, nsvt, syncope hx, bp fall with exercise

Question 10

giant cell myocarditis

Answer 10

T cell mediated
rapid progressive, often fatal
rx thymoglobulin, corticosteroids, calcineurin inhib.
may be associated with other autoimmune dx

Question 11

chagas dx

Answer 11

typannosoma cruzi
portal of entry - chagoma
fevers, hepatosplenomegaly, myocarditis
worse with worse heart function
rx nitrofurtimox in acute phase, chronic may benefit antiparasitic rx

Question 12

Lyme disease cardiac
disease hallmark
card effects
vector: 
cause, dx, rx

Answer 12

erythema migrans, joint involvement, meningoencephaltis
carditis: palpitations, conduction abnl, myocarditis, lv failure
vector: black legged tick
bacterium Borrelia burgdorferi
serologies: IgM positivity rx iv ceftriax if card involvment

Question 13

Lupus card effects

Answer 13

systolic or diastolic dysfunction
conduction delays
bx shows mononuclear cell

Question 14

Hypersensitivity myocarditis
clinical
causes

Answer 14

fevers, rash, peripheral eosinophilia- rx remove agent, corticosteroid
med induced: hctz, furosemide, amp, tetracycline, methyldopa, azithromycine, aminophylline, phenytoin, benzo, tca

Question 15

Myocardial and celiac disease/ rx

Answer 15

5% of celiac pts have myocarditis

improves with gluten free diet

Question 16

Cardiac amyloid
types
rx
genetic counseling
prognosis

Answer 16

AL, senile, transthyretin
AL can be rx with chemo and occasional stem cell xplant
transthyretin with liver xplant (usually presents 3rd decade)
familial usually transthyretin- genetic counsel
senile better prog than AL (7.5 vs 15 mths after chf presentation

Question 17

Cardiac Sarcoidosis
cause
dx

Answer 17

t lymphocytes, noncaseating granulomas
5% card involvement
dx abnl echo, perfusion defect, delayed Gd enhancement,

Question 18

infiltrative cardiomyopathies

Answer 18

fabry
friedreich ataxia
wegeners
danon

Question 19

restrictive cardiomyopathies

Answer 19

amyloid, sarcoid, endomycardial fibrosis, noncompaction (icd and warfarin rx)

Question 20

Staging for CHF

Answer 20

A: high risk, but without structural dz or chf
B: structural dz, but no signs/symptoms of chf
C: structural dz, with prior or current hf symptoms
D refractory of Hf

Question 21

BNP vs NT BNP

Answer 21

NT 5-10x bnp in some pts
both affected by age and renal function
Ed >500 90% pos pred value
4000 predict mort and readmit

Question 22

CPET

Answer 22

<14 cc/kg/min xplant

ve/vco2 increased mort increased mortality hf

Question 23

HOPE trial

Answer 23

ramapril prevention of heart failure

Question 24

ace intolerant studies

Answer 24

valheft and charm studies

charm with 3 arms- alternative to ace, added to ace, and arb with preserved lv function

Question 25

ephesus

Answer 25

eperenone
selective aldosterone blocker
lv dysfunction post mi- death, chf improved

Question 26

Dig trial

Answer 26

EF <45%
no survival benefit
less hospitalizations

Question 27

risk of diastolic dysfunction

Answer 27

htn
age
female
obesity

Question 28

bi v pacing recommended:

Answer 28

nsr
qrs>120 ms
ef<35%
moderate to severe chf NYHA3 with omt

Question 29

xplant evaluation
rt heart cath
med eval

Answer 29

pvr goal <3 pvr = (mean pa-pcwp)/ co

blood type, pra, hiv, hepc, hep b

Question 30

immunosuppressive rx

Answer 30

cyclosporin/tacrolimus primary
adjunctive: mycophenolate
suportive prednisone
statins additive

Question 31

immunosuppresives:

classes

Answer 31

calcineurin inhibitors (cyclosporin/ tacrolimus)
mycopheolate mefetil (cellcept)
corticosteroids
cytolytic therpay
il2 blockers

Question 32

type of rejection

Answer 32

hyperacute
cellular
vascular

Question 33

transplant vasculopathy

Answer 33

CAV leading cause of death 5 yrs

contributing factors: immunosuppressive agents, cmv, atherosclerosis rf

Question 34

McConnell sign

Answer 34

RV hypo with nl RV apical function