9.8.2013(Heart Failure)

Question 0

Stage A heart failure

Answer 0

No symptoms
No structural disease 
Only risk factors present
  CAD
  hypertension
  DM
  toxins
  Cardiomyopathy

Question 1

Precipitants of heart failure

Answer 1

Infection
Volume overload
Thyroid dysfunction
Myocardial ischemia
Hypertension
Arrythmias
Alcohol
NSAID
CCB
doxorubicin
Pulmonary embolism

Question 2

Rx of stage A heart disease

Answer 2

Dietary modifications
Treat hyperlipidemia
ACE inhibitors for HTN

Question 3

Stage B heart failure

Answer 3

Abnormal LV systolic function
MI
valvular Heart disease
No symptoms

Question 4

Rx of stage B heart failure

Answer 4

ACEI

beta blockers

Question 5

Stage C heart failure

Answer 5

Structural HF with symptoms

Question 6

Rx of stage C heart disease

Answer 6

ACEI
beta blockers
Diuretics
Digoxin

Question 7

Stage D heart failure

Answer 7

Heart failure symptoms refractory to maximal medical management

Question 8

Rx of stage D heart failure

Answer 8

Mechanical assist devices
Cardiac transplantation
Continuous IV inotropic support

Question 9

BNP levels and heart failure

Answer 9

BNP>400 in the absence of renal failure is specific

BNP<100 has high negative predictive value

Question 10

Testing to be done in new onset heart failure without CAD

Answer 10

HIV
hepatitis
Hemochromatosis 
ANA,ANCA
Amyloidosis
Pheochromocytoma

Question 11

Role of cardiac MRI in assessing heart failure

Answer 11

Valvular disease
Amyloidosis
Sarcoidosis 
Myocarditis
Previous MI

Question 12

Role of cardiopulmonary exercise testing in heart failure

Answer 12

Assessment for heart transplantation

Question 13

Role of coronary angiography in heart failure

Answer 13

In pts with angina or evidence of ischemia in ECG or stress testing unless they are not candidates for revascularisation

Question 14

Effects of beta blockers in heart failure

Answer 14

Improves ejection fraction,exercise tolerance,NYHA class

Question 15

Time taken for improvement in LV function after instituting Betablocker therapy

Answer 15

2-3 months

Question 16

Adverse cardiac effects immediately reduced after institution of Betablocker therapy

Answer 16

Arrythmias

Sudden cardiac death

Question 17

Adverse reactions that may occur after initiation of Betablocker therapy

Answer 17

Volume retention and worsening of heart failure symptoms,these improve with use of diuretics

Question 18

Beta blockers with proven benefit on mortality

Answer 18

Carvedilol
Metoprolol
Bisoprolol

Question 19

When should one be cautious when using vasodilators in heart failure

Answer 19

Diastolic dysfunction
Fixed cardiac output states
AS
HOCM

Question 20

Beneficial effects of ACE inhibitors in heart failure

Answer 20

Attenuate vasoconstriction,vital organ hypoperfusion,hyponatremia,Hypokalemia and fluid retention

Question 21

Use of ACE inhibitors in heart failure

Answer 21

Improve systolic dysfunction 
Asymptomatic systolic dysfunction
CAD
DM
HTN

Question 22

Adverse effects of ACE inhibitors

Answer 22

Renal insufficiency in B/L renal artery stenosis
Hyperkalemia
Rashes
Angioedema
Dysgeusia
Increased serum creatinine
Proteinuria
Leukopenia
Cough

Question 23

Agranulocytosis and angioedema is common in which ACE inhibitor

Answer 23

Captopril

Especially in pts with associated collagen vascular disease or Cr more than 1.5mg%

Question 24

Vasodilator combination that reduces mortality in heart failure

Answer 24

Hydralzine | Isosorbide dinitrate

Question 25

Preferred vasodilator for treatment of heart failure in acute MI or unstable angina

Answer 25

Nitroglycerin

Question 26

Use of sodium nitroprusside in heart failure

Answer 26

MR AR Hypertensives

Question 27

Thiocyanate toxicity

Answer 27

``` Paresthesia Nausea Mental status changes Abdominal pain Seizures ```

Question 28

Toxic levels of Thiocyanate

Answer 28

>10mg/dl

Question 29

Sodium nitroprusside should be used with caution in myocardial ischemia because

Answer 29

Coronary steal phenomenon

Question 30

Side effects of nitroprusside treatment

Answer 30

Cyanide toxicity | Methhemoglobinemia

Question 31

Use of nesiritide

Answer 31

Acute heart failure exacerbations

Question 32

Contraindication for use of nesiritide

Answer 32

SBP less than 90mm of Hg

Question 33

Enlapril 2.5mg oral per day is equivalent to enlaprilat _______

Answer 33

0.625mg IV 6th hourly

Question 34

Role of alpha blockers in heart failure

Answer 34

No role

Question 35

Therapeutic serum digoxin levels

Answer 35

0.8-2 ng/ml

Question 36

Dose of digoxin should be reduced in

Answer 36

Renal failure

Question 37

Drugs that increase digoxin levels

Answer 37

``` ERYTHROMYCIN TETRACYCLINE Quinidine Verapamil Flecainide Amiodarone ```

Question 38

Digoxin toxicity is enhanced by

Answer 38

``` Hypokalemia Hypoxemia Hypothyroidism Renal insufficiency Volume depletion ```

Question 39

Thiazide that is useful in pt with low GFR

Answer 39

Metolazone

Question 40

How lasix is useful in HF and acute pulmonary Edema

Answer 40

Reduces preload by causing direct venodilation

Question 41

Loop diuretics that can be safely used in Sulfa sensitive patients

Answer 41

Ethacrynic acid

Question 42

Role of spironolactone in heart failure

Answer 42

NYHA class III-IV pts with creatinine less than 2.5mg/dl and K+ less than 5mEq/L

Question 43

Role of milrinone

Answer 43

Refractory heart failure

Question 44

Maximum daily dose of frusemide

Answer 44

400mg