Assessment Exam 4: Heart Failure Flashcards

Question

Which factor does NOT directly determine the left ventricle's ability to fill? A) Pulmonary venous blood flow B) Left atrial (LA) function C) Systemic vascular resistance D) Mitral valve dynamics

Answer 1

Correct Answer: C) Systemic vascular resistance Rationale: Systemic vascular resistance primarily affects the afterload against which the heart pumps, not the filling of the left ventricle. Pulmonary venous blood flow, left atrial function, mitral valve dynamics, and pericardial restraint are factors that contribute to the left ventricle's ability to fill.

Answer 2

Correct Answer: D) Sufficient preload without elevated pulmonary venous pressures and LA pressures Rationale: Normal LV diastolic function is indicated when the LV can accommodate an adequate preload that provides sufficient cardiac output for cellular metabolism without the consequence of elevated pulmonary venous pressures and left atrial pressures.

Answer 3

Correct Answer: B) Contractile dysfunction of the left ventricle Rationale: In HFrEF, also known as systolic heart failure, the primary issue is contractile dysfunction of the left ventricle, which leads to a decreased ability of the heart to pump blood efficiently during systole, resulting in a reduced ejection fraction.

Answer 4

Correct Answer: C) Pericardial restraint Rationale: Pericardial restraint refers to the pericardium's influence on the heart's ability to expand during filling. In conditions where the pericardium is stiff or constricted, as in constrictive pericarditis, it can significantly hinder the heart's diastolic filling by limiting the ventricular expansion.

Answer 5

Correct Answer: B) Decreased LV compliance Rationale: A steeper end-diastolic pressure-volume curve indicates delayed LV relaxation and increased myocardial stiffness, which translates to decreased compliance of the left ventricle.

Answer 6

Correct Answer: C) Left atrial (LA) hypertension and pulmonary venous congestion Rationale: LVDD results in increased LV filling pressures due to reduced compliance, which can precipitate LA hypertension, leading to pulmonary venous congestion and subsequently, symptoms such as dyspnea and exercise intolerance.

Answer 7

Correct Answer: C) Heart rate, loading conditions, and myocardial contractility Rationale: The assessment of LVDD is complex and depends on multiple dynamic factors, including the heart rate, ventricular preload and afterload (loading conditions), and the contractility of the myocardium.

Answer 8

Correct Answer: B) Higher than normal LV filling pressures Rationale: In HFpEF, due to the decreased compliance of the LV, higher filling pressures are required to achieve a normal end-diastolic volume, which contributes to the symptoms and complications associated with this condition.

Answer 9

Correct Answer: B) Exercise intolerance Rationale: Exercise intolerance is a common symptom in LVDD, as the stiffening of the left ventricle and the resulting increase in filling pressures lead to difficulty in increasing cardiac output during exercise, along with associated symptoms like dyspnea and fatigue.

Answer 10

Correct Answer: A) Pressure-overload hypertrophy Rationale: Pressure-overload hypertrophy is typically seen in conditions that increase resistance to ventricular ejection, such as aortic stenosis or hypertension, which require the myocardium to generate greater force during systole.

Answer 11

Correct Answer: B) Hypertrophic obstructive cardiomyopathy Rationale: Hypertrophic obstructive cardiomyopathy is characterized by abnormal thickening of the heart muscle, particularly the ventricular septum, leading to obstruction of blood flow and diastolic dysfunction.

Answer 12

Correct Answer: C) Restrictive cardiomyopathy Rationale: Restrictive cardiomyopathy is often caused by diseases like amyloidosis or hemochromatosis, which lead to the deposition of abnormal substances within the heart tissue, reducing its compliance and ability to fill properly during diastole.

Answer 13

Correct Answer: B) Pericardial diseases such as tamponade or constrictive pericarditis Rationale: Pericardial diseases like tamponade and constrictive pericarditis lead to external restriction of the heart's normal filling during diastole, contributing to diastolic dysfunction.

Answer 14

Correct Answer: C) Combined systolic and diastolic dysfunction Rationale: Acute myocardial ischemia can result in both systolic and diastolic dysfunction due to the impairment of the heart muscle's ability to contract and relax effectively.

Answer 15

Correct Answer: C) Delayed relaxation of the left ventricle due to actin-myosin interactions Rationale: Active stiffening refers to the delayed relaxation phase of the left ventricle, often caused by the failure of actin-myosin dissociation due to dysfunctional intracellular calcium homeostasis.

Answer 16

Correct Answer: D) Hypertension Rationale: Hypertension typically elevates afterload, which is the pressure the heart must work against to eject blood, and can lead to difficulties with left ventricular relaxation.

Answer 17

Correct Answer: C) It exacerbates the failure of LV relaxation Rationale: Tachycardia can worsen the failure of left ventricular relaxation by shortening diastolic filling time, leading to insufficient time for the ventricle to relax and fill adequately.

Answer 18

Correct Answer: B) Profound exercise intolerance Rationale: Patients with HFpEF may experience profound exercise intolerance due to the heart's inability to properly fill and respond to increased demands during physical activity, despite having only modestly depressed systolic function.

Answer 19

Correct Answer: B) Subendocardial ischemia and further reduced exercise tolerance Rationale: Prolonged compression of the coronary arteries, particularly during diastole, can lead to subendocardial ischemia due to impaired coronary blood flow. This exacerbates the symptoms of diastolic dysfunction, notably the reduction in exercise tolerance.

Answer 20

Correct Answer: B) S3 gallop Rationale: An S3 gallop is more commonly associated with HFrEF and is a low-pitched sound occurring at the end of the rapid filling phase of the left ventricle, indicative of increased ventricular volumes and pressures.

Answer 21

Correct Answer: B) Paroxysmal nocturnal dyspnea Rationale: Paroxysmal nocturnal dyspnea, which is waking up at night with shortness of breath and needing to sit or stand up to relieve it, is more commonly associated with HFpEF.

Answer 22

Correct Answer: B) Presence of HF symptoms in the setting of reduced EF Rationale: The diagnosis of HFrEF is established when a patient presents with symptoms of heart failure and an ejection fraction that is reduced (≤40%), as confirmed by echocardiographic assessment.

Answer 23

Correct Answer: D) Cyanosis Rationale: While peripheral and dependent edema, as well as pulmonary edema, are symptoms associated with HFpEF, cyanosis is not typically a direct presentation of HFpEF.

Answer 24

Correct Answer: C) Distended neck veins Rationale: Distended neck veins are a clinical manifestation of elevated jugular venous pressure (JVD), often seen in heart failure due to the increased right atrial pressure transmitted back into the venous system.

Answer 25

Correct Answer: D) HFpEF patients may have little to no symptoms at rest Rationale: HFpEF can be more challenging to diagnose initially, especially since patients may have minimal or no symptoms while at rest, despite having significant diastolic dysfunction and heart failure symptoms with exertion.

Answer 26

Correct Answer: B) Right ventricle (RV) Rationale: Direct measurement of the right ventricular (RV) filling pressures offers further insights into the severity of HFpEF, as it reflects the back-pressure transmitted from the left heart through the pulmonary circulation to the right heart.

Answer 27

Correct Answer: A) Greater than 15mmHg at rest or 25mmHg during exercise Rationale: A mean PCWP exceeding 15mmHg at rest or 25mmHg during exercise provides strong evidence of HFpEF and also serves as a predictor of mortality in these patients.

Answer 28

Correct Answer: C) LV systolic and diastolic stiffness Rationale: Provocative testing during cardiac catheterization, which may include exercise or rapid intravenous volume expansion, is used to evaluate LV stiffness both at the level of systole and diastole. It can reveal dysfunction that might not be apparent at rest.

Answer 29

Correct Answer: C) Distension of the pulmonary veins in the upper lobes Rationale: An early radiographic sign of LV failure and pulmonary venous hypertension on a CXR is the distension of the pulmonary veins in the upper lobes of the lungs.

Answer 30

Correct Answer: B) As Kerley lines with a honeycomb pattern Rationale: Interlobar edema in the setting of heart failure may manifest as Kerley lines on CXR, which are thin linear pulmonary opacities caused by fluid accumulation in the interlobular septa and present a honeycomb pattern.

Answer 31

Correct Answer: B) Alveolar edema Rationale: Alveolar edema, which is a severe form of pulmonary edema due to fluid overflow into the alveolar spaces, typically produces homogeneous densities across the lung fields in a butterfly or bat wing pattern on CXR.

Answer 32

Correct Answer: B) Up to 12 hours Rationale: Radiographic evidence of pulmonary edema on CXR may lag behind the actual clinical presentation by up to 12 hours, which underscores the importance of clinical correlation.

Answer 33

Correct Answer: A) Pleural and pericardial effusion Rationale: Both pleural effusion and pericardial effusion can be associated with heart failure and may be evident on CXR, indicative of fluid accumulation due to the compromised cardiac function.

Answer 34

Correct Answer: A) ACC/AHA criteria Rationale: The ACC/AHA diagnostic criteria, based on heart failure symptoms, EF >50%, and evidence of LV diastolic dysfunction, may be too simplistic for detecting subclinical HFpEF, as these criteria are designed for clear symptomatic presentations.

Answer 35

Correct Answer: D) Provocative testing during echocardiography Rationale: The ESC criteria for the diagnosis of HFpEF are specific and incorporate several echocardiographic indices but do not include provocative testing, which is an important limitation of the guidelines.

Answer 36

Correct Answer: C) They rely entirely on resting echocardiogram without provocative testing Rationale: The ESC guidelines for the diagnosis of HFpEF rely entirely on resting echocardiographic measurements and are limited by the lack of provocative testing, which could reveal diastolic dysfunction not apparent at rest.

Answer 37

Correct Answer: B) E/e' ratio Rationale: The E/e' ratio is an echocardiographic measurement of diastolic function included in the ESC criteria for HFpEF diagnosis. It is indicative of increased left atrial pressure and is not specifically mentioned in the ACC/AHA criteria as highlighted in the image.

Answer 38

Correct Answer: C) B-type natriuretic peptide (BNP) or NT-proBNP Rationale: B-type natriuretic peptide (BNP) or NT-proBNP levels are included in the ESC criteria for HFpEF diagnosis and are used to support the presence of heart failure, with specific cut-off values provided for clinical consideration.

Answer 39

Correct Answer: C) Low predictive value Rationale: EKG alone has a low predictive value for the diagnosis or risk prediction of heart failure. It can show abnormalities indicative of heart failure or related cardiac conditions but is not sufficient on its own for a definitive diagnosis.

Answer 40

Correct Answer: D) Pulmonary embolism Rationale: An EKG can show abnormalities related to LVH, previous MI, and arrhythmias like atrial fibrillation, which are associated with heart failure, but it is not the primary diagnostic tool for pulmonary embolism.

Answer 41

Correct Answer: C) Brain natriuretic peptide (BNP) or N-terminal pro-BNP Rationale: In HFpEF, where there is concentric hypertrophy and relatively normal LV chamber size, the LV end-diastolic wall stress is lower, allowing for lower BNP or NT-proBNP levels compared to HFrEF, which is associated with higher LV end-diastolic wall stress due to LV dilation and eccentric remodeling.

Answer 42

Correct Answer: B) Related to LV end-diastolic wall stress Rationale: Natriuretic peptide concentrations, such as BNP and NT-proBNP, are directly related to LV end-diastolic wall stress, not simply the systolic function. Elevated levels suggest increased wall stress, often due to volume or pressure overload as seen in heart failure.

Answer 43

Correct Answer: B) Myocardial damage Rationale: Troponins are systemic biomarkers released due to myocardial damage and are used as a measure of risk prediction in various cardiac conditions, including heart failure.

Answer 44

Correct Answer: C) C-reactive protein (CRP) Rationale: CRP is an acute-phase reactant and a biomarker of inflammation. Elevated CRP levels in heart failure can indicate the inflammatory component of the disease process. and growth differentiation factor-15 (GDF15) represent the inflammatory component of HF

Answer 45

Correct Answer: C) Due to decreased wall stress from concentric hypertrophy Rationale: In HFpEF, the hypertrophy of the myocardium is concentric without significant chamber dilation, leading to relatively normal LV chamber size and lower LV end-diastolic wall stress, which accounts for the lower natriuretic peptide levels.

Answer 46

Correct Answer: B) The degree of physical limitation in heart failure patients Rationale: The NYHA classification system for heart failure focuses on the degree of physical limitation and symptoms during physical activity, rather than the structural abnormalities of the heart.

Answer 47

Correct Answer: A) Stage A Rationale: Stage A in the ACC/AHA classification system refers to individuals at high risk of developing heart failure who do not yet have structural heart disease or symptoms of heart failure.

Answer 48

Correct Answer: B) Progression is associated with a reduced 5-year survival rate Rationale: The progression of heart failure is linked to a poorer prognosis, including a reduced 5-year survival rate, highlighting the importance of early intervention and management to slow disease progression.

Answer 49

Correct Answer: B) Class B Rationale: In the ACC/AHA classification system, a patient with structural heart disease but without symptoms falls under Class B, which indicates structural abnormalities without symptomatic heart failure.

Answer 50

Correct Answer: B) Heart Failure with reduced Ejection Fraction (HFrEF) Rationale: The slide indicates that there has been an improvement in the survival of patients with HFrEF over the past three decades, while mortality in those with HFpEF remains unchanged.

Answer 51

Correct Answer: B) Beta-blockers (BB's) and ACE-inhibitors Rationale: The treatment for HFrEF primarily includes beta-blockers and ACE-inhibitors, as these medications have been shown to improve survival in these patients.

Answer 52

Correct Answer: A) Medication treatments Rationale: Medication treatments are generally ineffective for HFpEF, though benefits are seen in patients with HFrEF. Management of HFpEF often focuses on symptom mitigation and treating associated conditions.

Answer 53

Correct Answer: A) Beta-blockers Rationale: Beta-blockers are not mentioned as a treatment for HFpEF on the slide. Instead, treatment focuses on symptom mitigation, addressing comorbid conditions, encouraging exercise, and weight loss.

Answer 54

Correct Answer: B) Diuretics Rationale: Diuretics are the first line of treatment in the algorithm for HFpEF patients experiencing volume overload to manage symptoms and improve functional status.

Answer 55

Correct Answer: C) Consideration of a disease management program for heart failure Rationale: For patients with HFpEF who have been recently hospitalized, a disease management program for heart failure, possibly including pulmonary artery pressure-guided management, is suggested.

Answer 56

Correct Answer: A) Rate control and anticoagulation according to stroke risk scores Rationale: For HFpEF patients with atrial fibrillation, rate control and anticoagulation tailored to the individual's stroke risk are advised to manage both the atrial fibrillation and heart failure symptoms.

Answer 57

Correct Answer: A) Diuretics and ACE inhibitors or ARBs, if the patient has chronic kidney disease Rationale: In HFpEF patients with hypertension, especially those with chronic kidney disease, the algorithm suggests the use of diuretics and ACE inhibitors or ARBs, assessing other agents according to side effects and effectiveness.

Answer 58

Correct Answer: B) Referral to clinical trials of agents and devices for HFpEF Rationale: When symptoms persist in HFpEF despite the management of comorbidities and initial treatment strategies, referral to clinical trials for new therapeutic agents or devices is a suggested approach.

Answer 59

Correct Answer: B) Reducing LV filling pressures Rationale: Loop diuretics are recommended as they help reduce left ventricular filling pressures, decrease pulmonary venous congestion, and improve heart failure symptoms.

Answer 60

Correct Answer: C) To prevent the onset of HFpEF in patients with poorly controlled hypertension Rationale: Thiazide diuretics may be useful in patients with poorly controlled hypertension, a condition that can precipitate the onset of HFpEF.

Answer 61

Correct Answer: C) Heart Failure with preserved Ejection Fraction (HFpEF) Rationale: Beta-blockers are strongly recommended for HFrEF, but their benefit is not clearly established for HFpEF, although they are often prescribed for other indications such as hypertension, myocardial infarction, and heart rate control in atrial fibrillation.

Answer 62

Correct Answer: B) Atrial fibrillation (AFib) Rationale: While the benefit of BB's for HFpEF is not well-established, they are frequently prescribed for other indications like hypertension, myocardial infarction, and heart rate control in patients with atrial fibrillation.

Answer 63

Correct Answer: B) Loop diuretics are specifically recommended for their ability to improve symptoms by reducing left ventricular preload. Rationale: Loop diuretics are recommended for reducing left ventricular filling pressures and decreasing pulmonary venous congestion, according to ACC & ESC guidelines, and are particularly effective in improving symptoms by reducing LV preload.

Answer 64

Correct Answer: C. Patients with NYHA class III or IV and EF ≤ 5% and QRS duration 120-150 ms Rationale: CRT is indicated for patients with heart failure who are symptomatic despite optimal medical therapy, specifically those in NYHA functional class III or IV, with an EF ≤ 5% and a QRS duration of 120-150 ms, which represents a conduction delay and dyssynchrony that CRT can correct.

Answer 65

Correct Answer: C. Reduction in 10-year mortality by 7% Rationale: CABG has been shown to improve survival rates in the long term, with a significant reduction in 10-year mortality by 7%. This highlights the benefit of addressing coronary artery disease in the management of chronic heart failure to prevent progressive ventricular dysfunction.

Answer 66

Correct Answer: C. Device infection and displacement Rationale: While CRT offers several benefits, such as improved exercise tolerance and reduced mortality, it also carries risks common to cardiac device implantation, including infection and device displacement, which may necessitate reoperation or management of complications.

Answer 67

Correct Answer: C. Prevent ventricular remodeling and maintain the heart's natural geometry Rationale: Surgical interventions in chronic heart failure, such as revascularization and CRT, aim to prevent the pathological remodeling of the ventricles and to preserve the heart's structural integrity, which are essential for maintaining adequate cardiac function.

Answer 68

Correct Answer: B. Remote observation of intracardiac pressures Rationale: The CardioMEMS Heart Failure system is designed for the remote monitoring of pulmonary artery pressures, which correlate with left ventricular end-diastolic pressure and volume, thus indirectly indicating intracardiac pressures and aiding in the management of heart failure. This does not directly measure left ventricular ejection fraction, systemic vascular resistance, or central venous pressure.

Answer 69

Correct Answer: C. Correcting sudden cardiac dysrhythmias Rationale: ICDs are designed to prevent sudden death in patients with heart failure by automatically detecting and correcting life-threatening dysrhythmias, such as ventricular tachycardia or ventricular fibrillation. They do not directly improve myocardial contractility, reduce stroke risk, or increase cardiac output.

Answer 70

Correct Answer: B. 50% Rationale: As indicated, about 50% of deaths in patients with heart failure are due to sudden cardiac dysrhythmias. This statistic underscores the importance of interventions like ICDs in the management of patients with advanced heart failure.

Answer 71

Correct Answer: A. Adjust diuretic therapy dosage Rationale: The daily measurement of noninvasive PAP allows for dynamic management of heart failure, including the adjustment of diuretic therapy to prevent fluid overload and decompensation. While the monitoring may indirectly aid in assessing response to other therapies such as beta-blockers, it is not used to guide resynchronization therapy or anticoagulant medication dosing.

Answer 72

Correct Answer: B. Patients in terminal stages of heart failure with reversible conditions Rationale: LVADs can be used as a bridge to decision in patients who are in the terminal stages of heart failure with potentially reversible medical conditions. This allows time for the patient's condition to stabilize or improve so that a long-term decision regarding heart transplantation or other treatments can be made. Patients with aortic stenosis or stable chronic heart failure are typically not candidates for LVADs, and those with acute myocardial infarction and cardiogenic shock would require different acute interventions

Answer 73

Correct Answer: D. Improved survival and quality of life when compared to medical therapy alone Rationale: Peer-reviewed studies have consistently shown that VADs, particularly LVADs, improve survival rates and quality of life in patients with end-stage heart failure compared to medical therapy alone. While these devices can reduce the need for inotropic support and increase patient mobility, these are not the primary outcomes that have been emphasized in the literature.

Answer 74

Correct Answer: D. To provide palliative care and improve quality of life without curative intent Rationale: In patients with advanced heart failure who are not eligible for transplantation, an LVAD can be used as destination therapy. This is a form of palliative care intended to improve the quality of life without a curative approach, acknowledging that transplantation is not a viable option. While it does improve cardiac output, the term 'permanent solution' may be misleading as it does not cure the underlying disease.

Answer 75

Correct Answer: B. Rapid diuresis to reduce volume overload Rationale: Acute heart failure is characterized by rapid onset and often presents with life-threatening conditions such as pulmonary edema, requiring immediate intervention. Rapid diuresis is a common emergency treatment to decrease intravascular volume and relieve symptoms like dyspnea. While long-term management of heart failure may include beta-blockers, ACE inhibitors, and dietary modifications, these are not the primary acute interventions.

Answer 76

Correct Answer: C. De novo Acute Heart Failure (De novo AHF) Rationale: De novo AHF refers to patients presenting with heart failure symptoms for the first time. ADHF applies to patients with a previous diagnosis of heart failure who experience an acute worsening or decompensation of their condition. Chronic Heart Failure refers to a long-standing, typically progressive condition, while end-stage heart failure is the terminal phase of the disease.

Answer 77

Correct Answer: C. Decompensation due to inadequate compensation Rationale: Symptoms like fluid retention, weight gain, and dyspnea suggest a failure of compensatory mechanisms to maintain adequate cardiac output and systemic perfusion in heart failure. These symptoms are characteristic of decompensation and often prompt the need for hospitalization and acute management.

Answer 78

Correct Answer: B. Patients with both worsening of preexisting heart failure and new-onset heart failure Rationale: Acute heart failure applies to patients who present with an acute episode of heart failure, either as a worsening of preexisting heart failure (acute decompensated heart failure) or as a new presentation (de novo acute heart failure). It does not solely apply to those with heart failure from coronary artery disease nor to those who are stable on medications.

Answer 79

Correct Answer: C. Restoration of myocardial perfusion Rationale: In de novo AHF due to cardiac ischemia, prompt restoration of myocardial perfusion is vital to limit infarct size and improve outcomes, addressing the primary issue of coronary occlusion.

Answer 80

Correct Answer: C. Hypertensive emergency Rationale: Hypertensive emergencies commonly lead to acute heart failure exacerbations but are less likely to be an initial cause of de novo AHF compared to the other listed nonischemic conditions.

Answer 81

Correct Answer: B. Depends on the reversibility of the underlying etiology Rationale: The potential for complete restoration of cardiac function in de novo AHF is contingent upon the reversibility of the underlying cause, such as resolving ischemia or stopping a cardiotoxic agent.

Answer 82

Correct Answer: B. Titration of inotropic agents Rationale: Acute management of de novo AHF may require inotropic support to improve myocardial contractility and hemodynamics, especially when due to myocardial dysfunction.

Answer 83

Correct Answer: B. Decrease in pulmonary capillary wedge pressure (PCWP) Rationale: Diuretics are used to reduce intravascular volume, which in turn decreases central venous and pulmonary capillary wedge pressures, alleviating pulmonary congestion in AHF.

Answer 84

Correct Answer: C. Providing hemodynamic support with inotropic agents Rationale: In patients with AHF and hypotension, initial management often involves stabilizing hemodynamics, commonly with inotropic support, to address low cardiac output before diuretic therapy is considered.

Answer 85

Correct Answer: C. Reduce fluid overload Rationale: Loop diuretics are given to rapidly reduce fluid overload, which is a critical factor contributing to symptoms and mortality in AHF.

Answer 86

Correct Answer: B. Evaluating and optimizing the hemodynamic profile Rationale: Prior to surgery, a CRNA must assess and stabilize the patient's hemodynamics, as patients with AHF can present with low cardiac output and either high or low blood pressure, which could complicate anesthetic management and surgical outcomes.

Answer 87

Correct Answer: C. Rapid decrease in afterload Rationale: SNP acts as a potent vasodilator, effectively decreasing systemic vascular resistance and rapidly reducing afterload, which can help improve cardiac output in AHF.

Answer 88

Correct Answer: C. Their routine use is not associated with improved survival outcomes. Rationale: While vasodilators can correct hemodynamic derangements in AHF by reducing afterload and preload, their routine use has not been shown to improve survival or outcomes.

Answer 89

Correct Answer: B. Hyponatremia and volume overload Rationale: Tolvaptan, a vasopressin receptor antagonist, functions to alleviate hyponatremia and reduce volume overload by blocking the action of vasopressin, which promotes free water excretion without sodium loss.

Answer 90

Correct Answer: B. Underlying hemodynamic conditions Rationale: The use of vasodilators must be carefully considered in relation to the patient’s underlying hemodynamic status, as inappropriate use can lead to hypotension and worsen organ perfusion.

Answer 91

Correct Answer: C. Activating β-receptors to increase cAMP Rationale: Catecholamines such as epinephrine, norepinephrine, and dobutamine work by stimulating β-receptors on the myocardium, which activates adenylyl cyclase and leads to increased cyclic AMP (cAMP), enhancing contractility.

Answer 92

Correct Answer: B. Increasing cAMP levels Rationale: Phosphodiesterase inhibitors like milrinone increase cAMP levels by inhibiting its degradation, thereby improving contractility and vasodilation.

Answer 93

Correct Answer: B. Reduced contractility or cardiogenic shock Rationale: Positive inotropes are the mainstay treatment for acute heart failure patients with reduced contractility or those in cardiogenic shock to improve myocardial performance.

Answer 94

Correct Answer: B. Increase excitation-contraction coupling Rationale: Positive inotropes increase intracellular cAMP, which leads to increased calcium entry into myocardial cells, enhancing the excitation-contraction coupling and thereby improving

Answer 95

Correct Answer: B. Dobutamine Rationale: Dobutamine primarily stimulates β1-adrenergic receptors leading to increased cardiac output (CO) and heart rate (HR) with a variable effect on MAP, often minimal due to balanced β2-agonist activity causing vasodilation.

Answer 96

Correct Answer: B. Norepinephrine Rationale: Norepinephrine, due to its strong α-adrenergic activity, can increase CO modestly and MAP significantly, and it may cause reflex bradycardia or maintain HR due to its mild β1 effects.

Answer 97

Correct Answer: D. Calcium sensitization Rationale: Levosimendan enhances myocardial contractility by calcium sensitization, as well as through mild phosphodiesterase inhibition, without exerting direct adrenergic receptor stimulation.

Answer 98

Correct Answer: C. Brain Natriuretic Peptide (BNP) Rationale: Nesiritide is a recombinant version of Brain Natriuretic Peptide that works by binding to natriuretic peptide receptors and shares the same physiological effects as endogenous BNP.

Answer 99

Correct Answer: C. Direct increase in left ventricular ejection fraction Rationale: Nesiritide has several effects including RAAS inhibition, diuresis, natriuresis, and coronary vasodilation, but it does not directly increase left ventricular ejection fraction.

Answer 100

Correct Answer: D. It does not improve overall outcomes more than traditional vasodilators Rationale: Nesiritide has not shown an advantage over traditional vasodilators such as sodium nitroprusside (SNP) and nitroglycerin (NTG) in terms of improving overall treatment outcomes in acute heart failure.

Answer 101

Correct Answer: C. Inducing diuresis and natriuresis Rationale: Nesiritide assists in heart failure management by promoting diuresis and natriuresis, which helps to reduce fluid overload and improve symptoms such as dyspnea.

Answer 102

Correct Answer: A. Profile 1 Rationale: INTERMACS Profile 1, labeled "Crashing," describes patients with severe rest symptoms, intolerant of activity, and critically ill, often labeled as "moribund," indicating the highest urgency for MCS.

Answer 103

Correct Answer: B. Profile 7 Rationale: INTERMACS Profile 7, described as NYHA class III, is assigned to patients with a history of CHF who have minimal discomfort with exertion and are generally independent.

Answer 104

Correct Answer: B. Deflating during systole to reduce left ventricular end-diastolic pressure (LVEDP) Rationale: IABP functions by inflating after aortic valve closure (beginning of diastole) to increase coronary perfusion and deflating just before systole to reduce LVEDP, thus decreasing the work of the left ventricle.

Answer 105

Correct Answer: D. MRI Rationale: TEE and x-ray are the primary modes of evaluation for IABP placement. CT scans can be used in certain situations, but MRI is not typically used due to the presence of the balloon pump, which is not compatible with MRI.

Answer 106

Correct Answer: B. 1:2 (one inflation for every two heartbeats) Rationale: In tachycardic patients, a 1:2 ratio allows for a balance between adequate coronary perfusion and decreased afterload without overworking the heart with excessive balloon activity.

Answer 107

Correct Answer: C. Provides only modest improvements in cardiac output Rationale: While IABP can be a valuable tool in the management of acute heart failure, its effect on increasing cardiac output is relatively modest, typically in the range of 0.5–1 L/min, and it can render patients immobile, limiting its long-term use.

Answer 108

Correct Answer: D. Drawing blood from the LV and ejecting it into the ascending aorta Rationale: The Impella functions as a ventricular assist device by drawing blood from the LV through its distal port and ejecting it into the ascending aorta, thereby decreasing the workload of the LV.

Answer 109

Correct Answer: A. Inserted through the femoral artery and positioned in the LV Rationale: The Impella is a percutaneous ventricular assist device that is inserted through the femoral artery, advanced across the aortic valve, and positioned within the LV.

Answer 110

Correct Answer: B. Up to 14 days Rationale: The Impella can be used for up to 14 days, providing temporary support and serving as a bridge to definitive treatment such as surgery or transplantation.

Answer 111

Correct Answer: D. Permanent pacemaker implantation Rationale: The Impella is used as a bridge to recovery or as temporary support during high-risk cardiac procedures such as CABG, PCI, or transplant. It is not typically used as a bridge to permanent pacemaker implantation.

Answer 112

Correct Answer: C. Avoidance of Superior Vena Cava (SVC) syndrome Rationale: Central VAD/ECMO provides complete ventricular decompression and avoids the complications associated with peripheral cannulation, such as SVC syndrome, which can occur due to obstruction or compression of the SVC.

Answer 113

Correct Answer: C. The generation of heat leading to hemolysis and lower flows Rationale: Peripheral VADs can generate heat due to the smaller pump size, which can lead to more hemolysis and provide lower flow rates compared to central VADs.

Answer 114

Correct Answer: B. There is a need for complete ventricular decompression Rationale: Central ECMO is chosen over peripheral ECMO when there is a need for complete ventricular decompression, or if peripheral ECMO cannot provide adequate flow rates due to patient's anatomy or other limiting factors.

Answer 115

Correct Answer: B. Their smaller pumps and controllers Rationale: Peripheral VADs are equipped with small pumps and controllers that, despite generating heat, are more portable and thus facilitate patient transport.

Answer 116

Correct Answer: C. Functional shunting around the lungs Rationale: ECMO can lead to reduced lung perfusion as blood bypasses the pulmonary circuit, thereby diminishing the effectiveness of inhaled anesthetics due to functional shunting.

Answer 117

Correct Answer: C. Total Intravenous Anesthesia (TIVA) Rationale: TIVA is often considered for patients on ECMO due to the diminished effectiveness of inhaled anesthetics and because it allows for controlled delivery of anesthetic agents even when lung function is compromised or bypassed.

Answer 118

Correct Answer: B. Causing sequestration of lipophilic drugs such as fentanyl Rationale: The ECMO membrane's lipophilic nature can sequester lipophilic drugs, such as fentanyl, within the circuit, necessitating adjustments in dosing to achieve the desired therapeutic effect.

Answer 119

Correct Answer: A. Use higher initial doses of these drugs Rationale: The lipophilic properties of the ECMO circuit can absorb lipophilic drugs, often requiring higher initial doses or more frequent dosing to maintain therapeutic levels within the patient's circulation.

Answer 120

Correct Answer: A. Allow for differential support of the left and right ventricles Rationale: Decoupling support of the ventricles with BiVAD allows for independent management and weaning of left or right ventricular support, facilitating customized treatment based on the varying needs of each ventricle.

Answer 121

Correct Answer: C. Less invasive approach and potential for fewer complications Rationale: Percutaneous placement for BiVAD circuits is less invasive compared to central cannulation and may be associated with fewer complications and faster recovery.

Answer 122

Correct Answer: D. There is a need for right ventricular support only Rationale: Once a pt on central ECMO is stabilized, it may be desirable to decouple support of the ventricles with two independent circuits to allow for weaning of either the left- or right-sided support

Answer 123

Correct Answer: D. Overall increased 30-day mortality Rationale: Patients with heart failure are at an elevated risk for a variety of complications post-surgery, including longer requirements for mechanical ventilation and an increased risk for renal failure, sepsis, and pneumonia, contributing to a higher overall 30-day mortality rate.

Answer 124

Correct Answer: A. Allow for the optimization of comorbid conditions Rationale: Surgery in patients with decompensated heart failure or those experiencing a recent change in clinical status should be postponed to stabilize the patient's heart failure and optimize any comorbid conditions, thereby minimizing perioperative risk.

Answer 125

Correct Answer: B. If the patient is in a compensated state or requires treatment Rationale: Before surgery, all patients with heart failure should undergo a thorough preoperative assessment to evaluate if their heart failure is compensated or if there is a need for further medical treatment to manage their condition optimally

Answer 126

Correct Answer: B. If the patient is experiencing an acute decompensation of heart failure Rationale: Surgery should be postponed in heart failure patients who are experiencing acute decompensation or a recent change in clinical status, including the onset of de novo acute heart failure. This allows time for the acute episode to be treated and for the patient's condition to stabilize, minimizing perioperative risk and improving surgical outcomes.

Answer 127

Correct Answer: B. They should be continued throughout the perioperative period to mitigate risks. Rationale: The 2014 ACC/AHA guidelines recommend that patients undergoing surgery should maintain their ACE inhibitor therapy in the perioperative period. While ACE inhibitors may increase the risk of intraoperative hypotension, their continuation is important for managing heart failure and has been associated with reduced perioperative morbidity and mortality.

Answer 128

Correct Answer: D. To decrease the chance of intraoperative hypotension Rationale: Diuretics are often held on the day of surgery to minimize the risk of intraoperative hypotension that can result from reduced intravascular volume.

Answer 129

Correct Answer: C. Transthoracic echocardiogram Rationale: A transthoracic echocardiogram is indicated for patients with worsening dyspnea to evaluate cardiac function and structure.

Answer 130

Correct Answer: C. To adjust the settings for surgical interference Rationale: Preoperative interrogation of ICDs and pacemakers ensures appropriate device function and settings adjustment to avoid interference during surgery.

Answer 131

Correct Answer: C. BNP testing may not alter the management or outcome. Rationale: While BNP can be elevated in heart failure and has diagnostic value, it's not routinely recommended preoperatively because it may not necessarily change the perioperative management or improve outcomes in patients already diagnosed and managed for heart failure.

Answer 132

Correct Answer: C. They exhibit mechanical and/or electrical dysfunction. Rationale: Cardiomyopathies, irrespective of their type, are associated with mechanical and/or electrical dysfunction of the myocardium, often resulting in hypertrophy or dilation.

Answer 133

Correct Answer: B. Limited to the myocardium with no identifiable external cause. Rationale: Primary cardiomyopathies are confined to the heart muscle itself and are not due to systemic or extracardiac diseases, which are characteristic of secondary cardiomyopathies.

Answer 134

Correct Answer: B. Cardiac manifestations of a primary noncardiac condition. Rationale: Secondary cardiomyopathies involve pathophysiologic cardiac involvement within the broader context of a systemic or multioran disorder.

Answer 135

Correct Answer: B. Left ventricular hypertrophy (LVH) without another causative cardiac disease Rationale: HCM is characterized by LVH in the absence of other conditions that could induce such hypertrophy, such as hypertension or aortic valve disease.

Answer 136

Correct Answer: B. It has a prevalence of about 2-5 per 1,000 people. Rationale: HCM can affect all ages and has a relatively common prevalence of about 2-5 per 1,000 people.

Answer 137

Correct Answer: B. Hypertrophied myocardial cells with patchy fibrosis Rationale: The histologic features of HCM include hypertrophied myocardial cells and patchy fibrosis, which contribute to the clinical manifestations of the disease.

Answer 138

Correct Answer: A. The interventricular septum and the anterolateral free wall Rationale: HCM usually presents with hypertrophy of the interventricular septum and the anterolateral free wall of the left ventricle.

Answer 139

Correct Answer: C. Dysrhythmias Rationale: Dysrhythmias are a known cause of sudden death in young adults with HCM due to the disorganized myocardial architecture and scarring associated with the disease.

Answer 140

Correct Answer: C. Expanded interstitial matrix Rationale: The myocardium in HCM exhibits disorganized cellular architecture, myocardial scarring, and an expanded interstitial matrix, which predisposes to dysrhythmias.

Answer 141

Correct Answer: C. Prolonged relaxation time and decreased compliance Rationale: The hypertrophied myocardium in HCM has a prolonged relaxation time and decreased compliance, affecting diastolic function.

Answer 142

Correct Answer: B. Can occur regardless of the presence of CAD Rationale: Myocardial ischemia in patients with HCM can occur irrespective of the presence of CAD, as it is related to the hypertrophic and structural changes of the myocardium that impede adequate blood flow.

Answer 143

Correct Answer: C. Cardiac catheterization Rationale: Cardiac catheterization is an invasive procedure that allows for the direct measurement of hemodynamic parameters, including LVEDP, in patients with HCM.

Answer 144

Correct Answer: B. Myocardial wall thickness greater than 15 mm Rationale: An echocardiogram can show increased myocardial wall thickness, often greater than 15 mm, which is a hallmark of HCM.

Answer 145

Correct Answer: B. Is usually above 80%, reflecting hypercontractility Rationale: The ejection fraction in HCM is usually greater than 80%, indicating hypercontractile ventricular function, which is characteristic of the disease in non-terminal stages.

Answer 146

Correct Answer: C. High QRS voltage and possible ST-segment and T-wave changes Rationale: EKG abnormalities such as high QRS voltage and alterations in ST-segments and T-waves are commonly observed in 75-90% of patients with HCM.

Answer 147

Correct Answer: B. Can be severely depressed Rationale: Although HCM is characterized by hypercontractility, in terminal stages, the disease can progress to the point where ejection fraction is severely reduced.

Answer 148

Correct Answer: C. Negative inotropic effect Rationale: Disopyramide has a negative inotropic effect that can alleviate symptoms by reducing the degree of left ventricular outflow tract (LVOT) obstruction in HCM.

Answer 149

Correct Answer: C. Amiodarone Rationale: Amiodarone is considered the most effective antiarrhythmic drug for patients with HCM, particularly when managing associated Afib.

Answer 150

Correct Answer: C. Prevention of thromboembolism in chronic or recurrent Afib Rationale: Long-term anticoagulation is indicated in HCM patients with chronic or recurrent Afib due to the increased risk of thromboembolic events.

Answer 151

Correct Answer: A. Diuretics Rationale: Diuretics may be beneficial for symptom improvement in HCM patients who develop HF despite being on beta-blocker and calcium channel blocker therapy.

Answer 152

Correct Answer: B. Have large outflow tract gradients and remain symptomatic despite medical therapy. Rationale: Surgery, such as septal myectomy, is reserved for HCM patients who have significant outflow tract gradients and continue to experience severe symptoms despite optimized medical treatment.

Answer 153

Correct Answer: D. Prevent sudden cardiac death due to dysrhythmias. Rationale: ICD placement in HCM is a prophylactic treatment to prevent sudden cardiac death, which is often caused by dangerous dysrhythmias associated with the condition.

Answer 154

Correct Answer: B. To counteract the systolic anterior motion of the mitral leaflet Rationale: In HCM, if patients remain symptomatic after other treatments, a prosthetic mitral valve may be inserted to address systolic anterior motion of the mitral leaflet, which contributes to outflow tract obstruction.

Answer 155

Correct Answer: B. Induce targeted ischemia to reduce septal thickness. Rationale: Percutaneous septal ablation induces ischemia in the hypertrophied septum to reduce its thickness and thereby alleviate the outflow obstruction characteristic of HCM.

Answer 156

Correct Answer: C. Mimic the effects of a septal myectomy non-surgically. Rationale: This catheter-based technique reduces septal wall thickness by creating a controlled infarct in the hypertrophied area, similar to the reduction achieved with septal myectomy but without open surgery.

Answer 157

Correct Answer: B. LV or biventricular dilatation Rationale: DCM primarily involves dilatation of the left ventricle or both ventricles, associated with systolic dysfunction and without abnormal loading conditions or CAD.

Answer 158

Correct Answer: B. Mitral and tricuspid regurgitation Rationale: Ventricular dilatation in DCM can lead to valvular incompetence, most commonly manifesting as mitral and/or tricuspid regurgitation due to annular dilation and altered valve geometry.

Answer 159

Correct Answer: B. Heart failure Rationale: The initial clinical presentation of DCM is usually related to heart failure, which can include symptoms like dyspnea, fatigue, and exercise intolerance.

Answer 160

Correct Answer: A. Dysrhythmias Rationale: Dysrhythmias are common in DCM and can be life-threatening, contributing to the risk of emboli, conduction abnormalities, and sudden cardiac death.

Answer 161

Correct Answer: C. Myocardial ischemia, even in the absence of CAD Rationale: Chest pain in DCM can be a result of myocardial ischemia, which may occur due to the disease's effects on myocardial blood supply and demand, even when coronary arteries are not obstructed.

Answer 162

Correct Answer: B. Dilation of all four chambers with global hypokinesis Rationale: An echocardiogram in DCM generally shows dilation of all four chambers of the heart, with a predominant effect on the LV, and global hypokinesis indicating reduced myocardial contractility.

Answer 163

Correct Answer: C. Anticoagulation and heart failure medication management Rationale: Treatment for DCM often includes managing heart failure with medications, such as ACE inhibitors and beta-blockers, and anticoagulation therapy to reduce thromboembolic risk.

Answer 164

Correct Answer: B. ST-segment and T-wave abnormalities with Left bundle branch block (LBBB) Rationale: EKGs of patients with DCM often show ST-segment and T-wave abnormalities and can frequently demonstrate LBBB due to electrical conduction delays caused by ventricular dilation.

Answer 165

Correct Answer: B. Reducing the risk of sudden death by 50% Rationale: Prophylactic ICD placement in patients with DCM is indicated to reduce the risk of sudden cardiac death, typically due to life-threatening ventricular arrhythmias, by 50%.

Answer 166

Correct Answer: B. Dilated Cardiomyopathy (DCM) Rationale: DCM remains the principal indication for cardiac transplantation due to its progression to severe systolic dysfunction and heart failure, which are often refractory to medical treatment.

Answer 167

Correct Answer: C. "Apical ballooning syndrome" Rationale: Stress Cardiomyopathy is referred to as "Apical ballooning syndrome" because of the typical apical hypokinesis or ballooning of the left ventricle seen during systole on imaging studies, resembling a balloon with a narrow neck.

Answer 168

Correct Answer: C. Temporary disruption of contractility in the LV apex Rationale: Stress Cardiomyopathy is characterized by a temporary loss of contractile function at the apex of the left ventricle, while the rest of the heart typically maintains normal contractility.

Answer 169

Correct Answer: B. Women Rationale: Stress Cardiomyopathy occurs more frequently in women than in men, often triggered by physical or emotional stress.

Answer 170

Correct Answer: C. Stress (physical or emotional) Rationale: Stress Cardiomyopathy is often precipitated by acute emotional or physical stress, leading to a transient impairment in the heart's contraction, particularly affecting the apex of the left ventricle.

Answer 171

Correct Answer: B. Chest pain and dyspnea Rationale: Patients with Stress Cardiomyopathy often present with chest pain and dyspnea, symptoms that can mimic those of an acute coronary syndrome.

Answer 172

Correct Answer: A. Development of heart failure (HF) during the peripartum period Rationale: Peripartum Cardiomyopathy is diagnosed based on the development of HF in the period surrounding delivery, typically between the third trimester and 5 months postpartum, without another explainable cause, and with a left ventricular ejection fraction (LVEF) less than 45%.

Answer 173

Correct Answer: C. Holter monitoring Rationale: While Holter monitoring may be used in some cases, the standard diagnostic studies for Peripartum Cardiomyopathy include EKG, echocardiogram, CXR, cardiac MRI, cardiac catheterization, and measurement of BMP levels. Holter monitoring is more specific to arrhythmia detection.

Answer 174

Correct Answer: C. Identification of another explainable cause for heart failure Rationale: The diagnosis of Peripartum Cardiomyopathy requires the absence of another identifiable cause for the development of heart failure.

Answer 175

Correct Answer: C. Third trimester to 5 months postpartum Rationale: Peripartum Cardiomyopathy occurs during the peripartum period, which is defined from the third trimester to up to 5 months after delivery.

Answer 176

Correct Answer: C. Less than 45% Rationale: A reduced LVEF of less than 45% is a diagnostic criterion for Peripartum Cardiomyopathy, reflecting impaired systolic function.

Answer 177

Correct Answer: A. Amyloidosis Rationale: Among the systemic diseases that can lead to secondary cardiomyopathy, amyloidosis is the most common cause, characterized by the infiltration of abnormal proteins into the myocardium.

Answer 178

Correct Answer: B. Diastolic dysfunction Rationale: Secondary cardiomyopathies, such as those caused by amyloidosis, often result in severe diastolic dysfunction due to the stiffening of the myocardial tissue.

Answer 179

Correct Answer: B. In patients with heart failure symptoms but without systolic dysfunction or cardiomegaly Rationale: The diagnosis of secondary cardiomyopathy should be considered in patients presenting with heart failure without evidence of cardiomegaly or systolic dysfunction, suggesting an infiltrative or restrictive process affecting the myocardium.

Answer 180

Correct Answer: B. Orthostatic hypotension Rationale: Patients with secondary cardiomyopathy can develop orthostatic hypotension, a condition where blood pressure falls upon standing, due to their disease's effect on the heart's structure and function.

Answer 181

Correct Answer: C. Genetic Rationale: The genetic category includes conditions such as Hypertrophic cardiomyopathy and various ion channelopathies, indicating a hereditary component to their development.

Answer 182

Correct Answer: C. Acquired Rationale: Myocarditis is an example of an acquired cardiomyopathy as it results from external factors such as viral, bacterial, rickettsial, fungal, or parasitic infections.

Answer 183

Correct Answer: C. Mixed Rationale: Dilated cardiomyopathy is listed under the 'Mixed' category, suggesting it has both genetic and non-genetic factors in its pathophysiology.

Answer 184

Correct Answer: A. Genetic Rationale: Lenègre disease, characterized by progressive cardiac conduction system disease, is classified as a genetic cardiomyopathy.

Answer 185

Correct Answer: D. Other Rationale: Stress cardiomyopathy is classified under 'Other', suggesting it does not fit neatly into the genetic, mixed, or acquired categories.

Answer 186

Correct Answer: A. Infiltrative Rationale: Infiltrative cardiomyopathies involve the deposition of abnormal substances within the heart tissue, as seen in conditions like amyloidosis and Gaucher disease.

Answer 187

Correct Answer: B. Storage Rationale: Hemochromatosis, a storage disorder, leads to excessive accumulation of iron in various organs including the heart, classifying it under storage cardiomyopathies.

Answer 188

Correct Answer: C. Toxic Rationale: Toxic cardiomyopathies arise from exposure to certain substances, including recreational drugs like cocaine and therapeutic agents like certain chemotherapy drugs, which can be cardiotoxic.

Answer 189

Correct Answer: B. Endocrine Rationale: Endocrine disorders, such as diabetes mellitus, can affect the heart muscle's function and structure, placing them under the category of endocrine cardiomyopathies.

Answer 190

Correct Answer: B. Neuromuscular Rationale: Neuromuscular disorders like Duchenne-Becker dystrophy are known to affect the cardiac muscle, thereby classified under neuromuscular cardiomyopathies.

Answer 191

Correct Answer: D. COPD Rationale: COPD (Chronic Obstructive Pulmonary Disease) is the most frequent cause of Cor Pulmonale, leading to right ventricular enlargement due to the increased resistance in the pulmonary circulation.

Answer 192

Correct Answer: B. Right Ventricle (RV) Rationale: Cor Pulmonale specifically refers to right ventricular enlargement (hypertrophy and/or dilation), often due to pulmonary hypertension, which can lead to right-sided heart failure.

Answer 193

Correct Answer: B. Peaked P waves in leads II, III, and aVF Rationale: Right atrial hypertrophy in Cor Pulmonale can be suggested by peaked P waves in the inferior leads (II, III, and aVF) on an electrocardiogram (EKG).

Answer 194

Correct Answer: B. Right axis deviation and Right Bundle Branch Block (RBBB) Rationale: Cor Pulmonale often presents with right axis deviation and RBBB on an EKG, reflecting the electrical changes due to right ventricular hypertrophy.

Answer 195

Correct Answer: D. All of the above Rationale: TEE, right heart catheterization, and CXR are valuable diagnostics for assessing the extent of right heart involvement and the pulmonary vasculature in Cor Pulmonale.

Answer 196

Correct Answer: C. Poor lifestyle choices and comorbidities Rationale: HFpEF, where the heart muscle contracts normally but the ventricles do not relax as they should, is becoming more common, often due to poor lifestyle choices and comorbidities such as hypertension and obesity.

Answer 197

Correct Answer: B. Obstructive ischemic heart disease Rationale: HFrEF, characterized by a diminished ejection fraction, is commonly due to obstructive ischemic heart disease, where narrowed coronary arteries reduce blood flow to the heart muscle.

Answer 198

Correct Answer: A. Loop diuretics with vasodilators and positive inotropes Rationale: Acute heart failure management often involves loop diuretics to remove excess fluid, vasodilators to decrease the workload on the heart by widening blood vessels, and positive inotropes to increase the heart's pumping ability.

Answer 199

Correct Answer: A. The development of LVOT obstruction and ventricular arrhythmias Rationale: HCM is commonly associated with left ventricular outflow tract (LVOT) obstruction due to the thickened heart muscle and is a known cause of dangerous ventricular arrhythmias, which can lead to sudden cardiac death.

Answer 200

Correct Answer: C. Hypertrophic Cardiomyopathy (HCM) Rationale: HCM is the most common genetic cardiac disorder and is frequently associated with LVOT obstruction due to myocardial hypertrophy.

Answer 201

Correct Answer: C. Hypovolemia Rationale: Hypovolemia can worsen LVOT obstruction in HCM by decreasing the ventricular size, which in turn can increase the obstruction due to the hypertrophic myocardium. Factors that induce LVOT obstruction in HCM include hypovolemia, tachycardia, increased myocardial contractility, and decreased afterload

Answer 202

Correct Answer: C. Dilated Cardiomyopathy (DCM) Rationale: Dilated cardiomyopathy is the most common form of cardiomyopathy and represents a significant cause of heart failure due to its characteristic ventricular dilation and impaired systolic function.

Answer 203

Correct Answer: C. Pulmonary hypertension Rationale: Cor Pulmonale, which is right ventricular enlargement, is most often caused by pulmonary hypertension, a condition that places increased strain on the right side of the heart.

Answer 204

Correct Answer: B. Alveolar hypoxia Rationale: In chronic lung disease, alveolar hypoxia is the key factor that contributes to the development of pulmonary hypertension and subsequent Cor Pulmonale by causing vasoconstriction of pulmonary vessels.

Answer 205

Correct Answer: C. Long-term oxygen therapy Rationale: Long-term oxygen therapy is the treatment of choice for patients with chronic lung disease who develop pulmonary hypertension and Cor Pulmonale, as it addresses the root cause of alveolar hypoxia.

Assessment Exam 4: Heart Failure Flashcards

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