Acute Hf

Question 1

What is acute congestive heart failure?

Answer 1

Pathophysiological state with abnormality of cardiac function and inability of the heart to supply the tissues with blood enough for their metabolic needs.

Clinical syndrome arising from any structural or functional cardiac disorder that impairs the ability of the ventricles to fill with or eject blood to the tissues.

Question 2

What causes volume overload in acute congestive heart failure?

Answer 2

• Hypervolemia: acute renal failure and over infusion of fluids or blood
• Shunt lesions: Ventricular Septal Defect (VSD), ASD, PDA

These conditions lead to an increase in blood volume, affecting cardiac function.

Question 3

What causes pressure overload in acute congestive heart failure?

Answer 3

• Hypertension: pulmonary or systemic hypertension
• Obstructive lesions: Stenosis such as aortic stenosis or coarctation of the aorta

These factors increase the resistance against which the heart must pump.

Question 4

What is myocardial damage in the context of acute congestive heart failure?

Answer 4

• Myocarditis: viral, toxic
• Cardiomyopathy: dilated or constrictive & ischemic heart diseases
• Negative inotropic factors: hypoxia, hypoglycemia, and acidosis

These conditions impair the heart’s ability to contract effectively.

Question 5

What is arrhythmic failure?

Answer 5

Severe tachycardia (SVT) or bradycardia (Heart block).

This type of failure involves irregular heart rhythms that can compromise cardiac output.

Question 6

What is the clinical grading of congestive heart failure?

Answer 6

• Grade 1: Heart failure only
  *
• Grade 2: Heart failure and respiratory failure (Pulmonary edema)
• Grade 3: Heart failure and circulatory failure (Cardiogenic shock)

Each grade reflects the severity and symptoms of heart failure.

Question 7

What are the symptoms of Grade I congestive heart failure?

Answer 7

Heart failure only.

At this stage, patients may show minimal symptoms.

Question 8

What are the symptoms of Grade 1 congestive heart failure?

Answer 8

Tachypnea and tachycardia.

Patients begin to show signs of respiratory distress and increased heart rate.

Question 9

What are the symptoms of Grade 2 congestive heart failure?

Answer 9

• Moderate to severe respiratory distress
• Cyanosis
• Fine basal crepitation
• If pulmonary edema: Coarse & bubbling crepitation

This grade indicates significant respiratory involvement due to fluid accumulation.

Question 10

What are the symptoms of Grade 3 congestive heart failure?

Answer 10

• Severe respiratory distress with cyanosis
• Peripheral hypo-perfusion
• May lead to multiple organ failure (MOSF)

This is the most severe stage, indicating critical cardiac and systemic compromise.

Question 11

What laboratory findings are associated with pulmonary edema in congestive heart failure?

Answer 11

• CXR: marked congestion & pulmonary edema
• ABG: Hypoxia

These tests help confirm the presence and severity of heart failure.

Question 12

What is a symptom of pulmonary congestion associated with left ventricular failure (LVF)?

Answer 12

Dyspnea

Dyspnea can occur during exercise or even at rest.

Question 13

What does orthopnea refer to?

Answer 13

Dyspnea on lying flat

It is often associated with paroxysmal nocturnal dyspnea (PND).

Question 14

What indicates severe pulmonary edema in LVF?

Answer 14

Coarse generalized crepitations or bubbling with frothy pink secretions

This is a critical symptom in severe cases.

Question 15

What gastrointestinal symptoms can occur due to GIT congestion?

Answer 15

Dyspepsia, vomiting

This can lead to cardiac cachexia (weight loss).

Question 16

What causes weight loss in patients with congestive heart failure?

Answer 16

Malabsorption, Poor tissue perfusion, Muscle wasting

These factors contribute to overall weight loss.

Question 17

What type of edema is commonly seen in the lower limbs due to RVF?

Answer 17

Dependent and pitting edema

This edema is often more pronounced by the end of the day.

Question 18

What is a characteristic finding on cardiac auscultation in congestive heart failure?

Answer 18

Galloping heart with S3

This is due to the vibration of flappy myocardium.

Question 19

What does pulsus alternans indicate?

Answer 19

Alternation between strong and weak beats

It is a sign of varying stroke volume.

Question 20

What is oliguria?

Answer 20

Urine output less than 1 cc/kg/hour or 400 ml/day

This is a common symptom in kidney involvement of heart failure.

Question 21

What is a symptom of easy fatigue in patients with heart failure?

Answer 21

Claudication

This is often due to poor peripheral perfusion.

Question 22

Fill in the blank: A symptom of pulmonary congestion in LVF is _______.

Answer 22

Dyspnea

Question 23

True or False: Pulmonary edema in severe LVF can present with frothy pink secretions.

Answer 23

True

Question 24

What is the term for weight loss due to heart failure-related malabsorption?

Answer 24

Cardiac cachexia

This can result from poor tissue perfusion and muscle wasting.

Question 25

What type of edema is commonly observed in infants with RVF?

Answer 25

Sacral edema ## Footnote This is a specific finding in pediatric patients.

Question 26

What does CXR stand for in cardiology investigations?

Answer 26

Chest X-Ray

Question 27

What indicates cardiomegaly in a chest X-ray?

Answer 27

Increased cardiothoracic ratio > 0.5

Question 28

What does prominent vascular markings on a chest X-ray suggest?

Answer 28

Lung congestion

Question 29

What is a characteristic shadow seen in pulmonary edema on a chest X-ray?

Answer 29

Bats wing shadow

Question 30

What does a ventricular ECG help diagnose?

Answer 30

Arrhythmia (AF or VT)

Question 31

What does a ventricular echo measure?

Answer 31

Ventricular function (distinguish systolic and diastolic HF)

Question 32

What laboratory markers are used if myocarditis is suspected?

Answer 32

Creatine kinase (CPK) and troponin I

Question 33

What does CBC detect in the context of heart disease?

Answer 33

Anemia

Question 34

What is the purpose of measuring blood glucose in cardiology?

Answer 34

To detect diabetes mellitus (DM)

Question 35

What does serum iron test for in cardiology?

Answer 35

Hemochromatosis

Question 36

What does B-type Natriuretic Peptide (BNP) indicate?

Answer 36

Heart failure

Question 37

What is the NYHA classification used for?

Answer 37

Functional classification of heart failure

Question 38

What is the description of NYHA Class I?

Answer 38

No limitation of physical activity (Asymptomatic)

Question 39

What is the description of NYHA Class II?

Answer 39

Slight limitation of physical activity (Fatigue & Dyspnea) Ordinary activity

Question 40

What is the description of NYHA Class III?

Answer 40

Marked limitation of activity (Fatigue & Dyspnea) Less than Ordinary

Question 41

What is the description of NYHA Class IV?

Answer 41

Unable to do any physical activity (Symptomatic at Rest)

Question 42

What are the classifications of heart failure based on ventricular function?

Answer 42

* Systolic heart failure * Diastolic heart failure

Question 43

What are the classifications of heart failure based on cardiac output?

Answer 43

* Low cardiac output * High cardiac output

Question 44

What are the classifications of heart failure based on duration?

Answer 44

* Acute heart failure * Chronic heart failure

Question 45

What are the classifications of heart failure based on which ventricle is affected?

Answer 45

* Left-sided heart failure * Right-sided heart failure

Question 46

What condition is indicated by pulmonary edema?

Answer 46

Left-sided heart failure (LVF = Lung congestion)

Question 47

What complication arises from long-standing hepatic congestion due to right-sided heart failure?

Answer 47

Cardiac Cirrhosis

Question 48

What is a potential renal complication of heart failure?

Answer 48

Cardio-renal syndrome

Question 49

What does cardiac cachexia refer to?

Answer 49

Weight loss and muscle atrophy due to GIT malabsorption

Question 50

What electrolyte disturbances are associated with heart failure?

Answer 50

* Hypokalemia * Hyponatremia

Question 51

Fill in the blank: The classification of heart failure includes _______ and _______ based on ventricular function.

Answer 51

[Systolic heart failure, Diastolic heart failure]

Question 52

What are ACE inhibitors?

Answer 52

Angiotensin-converting enzyme inhibitors that act as both arteriolar and venous dilators. ## Footnote They help reduce after-load and pre-load, respectively.

Question 53

List contraindications for ACE inhibitors.

Answer 53

* Bilateral renal artery stenosis * Hyperkalemia * Concomitant use of potassium-sparing diuretic spironolactone (Max. 50 mg/day) ## Footnote These conditions can lead to serious complications when using ACE inhibitors.

Question 54

What is the dosage range for Captopril (Capoten)?

Answer 54

6 - 50 mg every 8 hours orally. ## Footnote Captopril is considered a cornerstone in heart failure treatment.

Question 55

What are the typical dosages for Enalapril and Lisinopril?

Answer 55

* Enalapril: 5 - 20 mg * Lisinopril: 5 - 20 mg daily ## Footnote These ACE inhibitors are used to manage heart failure.

Question 56

What beneficial effects do ACE inhibitors have in heart failure?

Answer 56

* Improve symptoms * Reduce mortality * Decrease frequency of hospitalization ## Footnote Several studies have confirmed these benefits.

Question 57

Who should be prescribed ARBs instead of ACE inhibitors?

Answer 57

Patients who cannot take ACE inhibitors due to cough or renal failure. ## Footnote ARBs do not affect bradykinin metabolism, thus avoiding cough.

Question 58

What are examples of ARBs and their typical dosages?

Answer 58

* Losartan: 50 mg daily * Valsartan: 80 mg daily ## Footnote ARBs are particularly useful in chronic heart failure.

Question 59

What is the mechanism of action of diuretics?

Answer 59

Increase in urinary sodium excretion leading to reduction in blood and plasma volume. ## Footnote This helps reduce preload and improve venous congestion.

Question 60

What is the dosage range for Furosemide (Lasix)?

Answer 60

40 - 120 mg/day orally. ## Footnote Furosemide acts on the loop of Henle and has a rapid onset of action.

Question 61

What are the side effects of Furosemide?

Answer 61

* Hypokalemia * Hyponatremia * Hypochloremic alkalosis * Hypocalcemia * Hyperuricemia * Hyperglycemia * Hyperlipidemia ## Footnote Furosemide can also be nephrotoxic and ototoxic.

Question 62

What is the site of action for Furosemide?

Answer 62

Acts on the thick ascending limb of the Loop of Henle. ## Footnote This is where it inhibits the cotransport of Na+, K+, Cl-, and H2O.

Question 63

What is the main action of Digitalis?

Answer 63

Increases cardiac contractility (inotropic effect) and excitability, decreases heart rate (negative chronotropic effect) ## Footnote Digitalis acts either directly or via vagal stimulation.

Question 64

How does Digitalis affect intracellular sodium and calcium levels?

Answer 64

Inhibits Na-K ATPase, leading to increased intracellular Na, which is exchanged for extracellular Ca ## Footnote This process enhances muscle contraction.

Question 65

In which conditions is Digitalis a better choice?

Answer 65

Atrial fibrillation (AF) and heart failure (HF) for ventricular rate control ## Footnote Especially in patients with symptoms of heart failure despite vasodilators and diuretics.

Question 66

What is a contraindication for the use of Digitalis?

Answer 66

Hypertrophic cardiomyopathy with diastolic dysfunction ## Footnote This condition is characterized by reduced left ventricular compliance.

Question 67

What is the typical oral dosage of Digitalis?

Answer 67

0.25 - 0.5 mg/kg divided into 2 equal daily doses (every 12 hours) ## Footnote Can also be administered intravenously.

Question 68

What are the two preparations of Digitalis mentioned?

Answer 68

* Digoxin (Lanoxin) - renal excretion * DigiToxin - hepatic metabolism

Question 69

What CNS symptoms can indicate Digitalis toxicity?

Answer 69

* Headache * Visual disturbances * Photophobia (colored yellow-green vision) ## Footnote These symptoms reflect the central nervous system effects of toxicity.

Question 70

What cardiovascular effects can Digitalis toxicity cause?

Answer 70

* Bradycardia * Heart block (except 2nd degree HB) * Increased excitability of atrium and ventricle * Arrhythmias (extrasystole, SVT) ## Footnote It decreases AV conduction and can lead to various arrhythmias.

Question 71

What ECG changes are associated with Digitalis toxicity?

Answer 71

* Prolonged P-R interval * Curved ST segment depression ## Footnote These changes are indicative of digoxin effects on cardiac conduction.

Question 72

What are factors that increase the risk of Digitalis toxicity?

Answer 72

* Hypokalemia * Hypercalcemia * Renal failure * Alkalosis * Accidentally large dose * Certain drugs (e.g., furosemide, thiazide, calcium, quinidine) * Old age * Thyroid disease

Question 73

What is the first step in the treatment of digitalis toxicity?

Answer 73

STOP digitalis

Question 74

What should be corrected in cases of digitalis toxicity?

Answer 74

Hypokalemia and hypercalcemia

Question 75

What medications are used to treat arrhythmias in digitalis toxicity?

Answer 75

* Phenytoin * Lidocaine

Question 76

What is the antidote for digitalis toxicity?

Answer 76

Digitalis antibodies (Digibind) or immunotherapy (Digoxin immune Fab)

Question 77

True or False: DC is advisable in the presence of digitalis intoxication.

Answer 77

False

Question 78

What position should a patient be in for adequate oxygenation?

Answer 78

Semi setting position

Question 79

What is the recommended fluid restriction for patients with hf?

Answer 79

60-70%

Question 80

What is the treatment approach for pulmonary edema in Grade II?

Question 81

What oxygen therapy methods are used for pulmonary edema?

Answer 81

* Continuous positive airway pressure (CPAP) * Mechanical ventilation

Question 82

What are the inotropic drugs used in the treatment of cardiogenic shock Grade III?

Answer 82

* IV dopamine * Dobutamine * Milrinone

Question 83

True or False: Digoxin is an appropriate treatment for cardiogenic shock due to its slow action and risk of toxicity.

Answer 83

False

Question 84

What specific causes may require treatment in cardiogenic shock?

Answer 84

* Valve lesion * Shunt * Rheumatic

Question 85

Etilogy of hf

Answer 85

Question 86

Sympotoms of Pulmonary cong Systemic cong Low co

Answer 86

Question 87

Inv done for therapy follow up

Answer 87

Echo

Question 88

Bat wing shadow

Answer 88

Pulmonary edema

Question 89

How to know lung cong

Answer 89

By cxr prominent vascular markings

Question 90

Mention BNP signifcance

Answer 90

Good negative test

Question 91

Mention inv done incase of hf

Answer 91

Question 92

Classsifcation of hf oral

Answer 92

Question 93

Mention comp of hf

Answer 93

Question 94

gr ; digoxin is not used in ttt of cardiogrnic shock

Answer 94

Slowly acting High risk for toxicity

Question 95

Gr; CPAP is used in both insp exp

Answer 95

To avoid re entry of h2o

Question 96

Mention صعوبه dopamine

Answer 96

Iv infusion

Question 97

Ttt of hf (supportive mesure)

Answer 97

Question 98

Ttt of cardiogenic shock

Answer 98

Question 99

Mention mecha of dilators ace i

Answer 99

Question 100

Who is cormer stone in hf ttt

Answer 100

Ace i

Question 101

Contra of ace i

Answer 101

Bilat renal artery stenosis’ Hyperkalemka Spironola tone

Question 102

Indication. Of arbs

Answer 102

Who cannot take ace i dt renal of cough

Question 103

Side effects of ace i

Answer 103

Dry irritant cough Angioneuritic edema

Question 104

Most useful vaso dilator in chronic hf

Answer 104

Arbs

Question 105

Mention furosmide Site Potency Action Side effects

Answer 105

Question 106

Mention DC incase of digitalis toxicity

Answer 106

Inadvisabel But if mandatory use low dose

Question 107

Ttt of digitalis toxicity

Answer 107

Stop diggalis Correct Ttt Antidote

Question 108

Factors inc risk for toxicity

Answer 108

Question 109

Mention metabolism for digioxin Digitoxin

Answer 109

Digoxin =renal Digitoxin = hepatic

Question 110

Contra of digitalis

Answer 110

Hpertrophic cardiomyopathy

Question 111

Digitalis action

Answer 111

Question 112

When to choose digitalis in ttt hf

Answer 112

Af with hf

Question 113

Serum toxic level ofr digitalis

Answer 113

>2mic\ml

Question 114

Earliset symptoms for digitalis toxicity

Answer 114

Git

Question 115

Mention cns symp for digitalis toxicity

Answer 115

Xanthopthia Photophobia Visual dist

Question 116

Mention hb degrees of digitalis toxicity

Answer 116

All except 2nd

Question 117

How to spot digitalis toxicity

Answer 117

Prolonged p-r S-t segment curved depresiom

Question 118

Mention cvs signs for didtalis toxicity

Answer 118