02.12 Heart Failure and Cor Pulmonale

Question 1

Most common lung disease that causes cor pulmonale

Answer 1

COPD

Question 2

Dilation and hypertrophy of the right ventricle in response to disease of the pulmonary vasculature and or lung parenchyma

Answer 2

Cor pulmonale

Question 3

Clinical manifestations of cor pulmonale

Answer 3

dyspnea, orthopnea, PND, abdominal pain , ascites

Tachypnea, elevated JVP, hepatomegaly, bipedal edema, cyanaosis

Question 4

Most common cause of RV failure

Answer 4

LV failure

Question 5

Right ventricular hypertrophy, right axis deviation

Enlargement of central main pulmonary artery and hilar vessels

Answer 5

Cor pulmonale

Question 6

Impaired ability of the ventricle to fill with blood

Answer 6

Heart failure with preserved ejection fraction

Question 7

Impaired ability to eject blood

Answer 7

Heart failure with reduced ejection fraction

Question 8

Cardinal clinical symptoms of heart failure

Answer 8

Dyspnea and fatigue

Question 9

Cardinal clinical signs of heart failure

Answer 9

Edema and rales

Question 10

Main causes of death in heart failure

Answer 10

Sudden cardiac death (arrythmic death)

Progressive HF

Question 11

According to Framingham Criteria: ____ die within 1 year (28% M, 24% F), while ____ die within 5 years (59% M, 45% F)

Answer 11

30-40%

60-70%

Question 12

Compensatory mechanism for heart failure

Answer 12

Activation of RAAS and adrenergic nervous system
Increased myocardial contractility and vasoconstriction
Release of vasodilating molecules

Question 13

Changes include myocyte hypertrophy, alterations in contractile properties, progressive loss of myocytes, beta-adrenergic desensitization, abnormal myocardial energetics and metabolism, reorganization of the cellular matrix

Answer 13

LV remodeling

Question 14

Patients with cardiac disease but without resulting limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitations, dyspnea or anginal pain

Answer 14

Class I (NYHA)

Question 15

Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitations, dyspnea or anginal pain

Answer 15

Class II

Question 16

Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea or anginal pain

Answer 16

Class III

Question 17

Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased

Answer 17

Class IV

Question 18

Framingham criteria: ___ major and ___ minor

Answer 18

2, 1

Question 19

Major criteria based according to Framingham

Answer 19

PND
Neck vein distention
Rales
Cardiomegaly
Acute pulmonary edema
S3 gallop
Increased JVP (>16 cm)
Hepato-jugular reflux
Weight loss > 4.5 kg in 5 days

Question 20

Minor Framingham criteria

Answer 20

Bilateral ankle edema
Nocturnal cough
Dyspnea on exertion
Hepatomegaly
Pleural effusion
Decrease in vital capacity
Tachycardia

Question 21

In determining the cause of HF, assess:

Answer 21

Severity, hemodynamic profile, response to therapy

Question 22

Late abdominal signs of HF

Answer 22

Ascites

Jaundice

Question 23

Cardiac manifestations of HF

Answer 23

Cardiomegaly (PMI displaced)
Apex beat > 2.5 cm (LVH)
S3 (ventricular contration)
S4 (atrial contraction)

Question 24

High negative predictive value for detection of HF

Answer 24

ECG

Question 25

Most useful for detection of LV function

Answer 25

2D echo/doppler

Question 26

Provides comprehensive analysis of cardiac anatomy and function
Gold standard for assessment of LV mass and volume
Useful in determining other cardiac causes like amyloidosis and hemosiderosis

Answer 26

MRI

Question 27

Sensitive markers for HF

Useful for prognosis, disease severity, optimal therapy guide

Answer 27

BNP/NT

Question 28

Useful prognostic marker

Answer 28

ST2

Question 29

In exercise testing, peak oxygen uptake of ____ is associated with poor prognosis (indication for transplant)

Answer 29

< 14 ml/kg

Question 30

Preload unloader

Answer 30

Diuretics (furosemide, spironolactone, indapamide)

Question 31

Afterload unloader

Answer 31

Vasodilator (ACE-I, ARBs)

Question 32

Criteria for discharge

Answer 32

24h of stable fluid status, blood pressure, renal function on the oral regimen planned for home
Free of dyspnea or asymptomatic hypotension while at rest and walking on the ward