Cardiology - Heart Failure

Question 1

The most common symptomatic valvular abnormality.

Answer 1

Aortic stenosis

Question 2

Causes of congestive heart failure from myocardial injury

Answer 2

• alcohol use
• cocaine
• ischemic cardiomyopathy (atherosclerosis)
• rheumatic fever
• viral myocarditis
• adriamycin (doxorubicin)

Question 3

Causes of heart failure from chronic pressure or volume overload

Answer 3

• aortic stenosis
• hypertension
• mitral regurgitation

Question 4

Causes of heart failure from infiltrator disease

Answer 4

• amyloidosis
• hemochromatosis

Question 5

A clinical syndrome that is produced when the heart is unable to meet the metabolic needs of the body while maintaining normal ventricular filling pressures.

Answer 5

Congestive heart failure

Question 6

Left ventricular failure with low cardiac output in pulmonary edema progresses to

Answer 6

Biventricular failure

Question 7

What does an S3 mean?

Answer 7

Ventricular gallop - the result of rapid, turbulent flow into the ventricle in early diastole as a result of high atrial pressure (exp. ventricular failure in severely dilated ventricle or decompensated HF)

Question 8

What does an S4 mean?

Answer 8

Atrial gallop - caused by turbulent filling of the ventricle in late diastole during a true contraction correlating with increased left ventricular stiffness (exp: hypertension)

Question 9

Goals of treatment for chronic heart failure

Answer 9

• relief of symptoms
• preventing disease progression
• reducing mortality risk

Question 10

Medications that reduce mortality in patients with heart failure

Answer 10

• ACEi
• ARB
• ANRi (Entresto)
• beta blockers
• hydralazine + nitrate (Bidil)
• MRA
• SGLT2i
• defibrillator

Question 11

Medications that improve prognosis

Answer 11

• beta blockers
• ACEi/ARB
• ARNi (Entresto)
• MRA
• hydralazine + nitrate (Bidil)
• SGLT2i

Question 12

What is the most common cause of death from CHF?

Answer 12

Arrhythmia causing sudden death

Question 13

Initial drug of choice in treating CHF due to survival advantage with use

Answer 13

ACE inhibitors

Question 14

Decreased ejection fraction and dilation of the heart

Answer 14

Systolic dysfunction

Question 15

Inability of the heart to relax and receive blood with normal ejection fraction

Answer 15

Diastolic dysfunction

Question 16

Clinical features of heart failure

Answer 16

• dyspnea on exertion
• orthopnea
• paroxysmal nocturnal dyspnea
• peripheral edema
• rales
• JVD
• S3 gallop

Question 17

Best initial test to evaluate ejection fraction

Answer 17

Transthoracic echocardiogram (TTE)

Question 18

Best test to evaluate valve function

Answer 18

Transesophageal echocardiogram (TEE) - not necessary for evaluating heart failure

Question 19

Indications for defibrillator

Answer 19

EF < 35% (elevated risk of sudden cardiac death due to ventricular arrhythmia)

Question 20

Indications for pacemaker

Answer 20

EF < 35% + wide QRS (LBBB)

Question 21

A congenital condition where asymmetrically enlarged hypertrophic septum leads to an obstruction of a ventricular outflow tract

Answer 21

Hypertrophic cardiomyopathy (HOCM)

Question 22

Types of heart failure

Answer 22

• systolic (HFrEF) - heart not pumping
• diastolic (HFpEF) - heart not relaxing

Question 23

The most common cause of HFpEF

Answer 23

Chronic systemic hypertension causing left ventricular hypertrophy

Question 24

Medication used for relief of congestion in acute heart failure

Answer 24

Loop diuretics

Question 25

Medications used to reduce preload and afterload while decreasing cardio-toxic hormones (angiotensin and aldosterone)

Answer 25

ACEi/ARB

Question 26

Medications with no mortality benefit

Answer 26

Digoxin

Question 27

A feature of decompensated heart failure where acute increases in left ventricular diastolic pressure cause rapid fluid accumulation in the pulmonary interstitium and alveolar spaces

Answer 27

Flash pulmonary edema

Question 28

The most common presenting symptom of acutely decompensated heart failure

Answer 28

Dyspnea

Question 29

The best physical examination surrogate were evaluating intravascular volume status

Answer 29

Jugular venous pressure (JVP)

Question 30

Chronic hyponatremia is commonly seen in advanced heart failure due to elevation in what hormone?

Answer 30

Due to elevation in ADH in response to low cardiac output

Question 31

A small pacemaker like device that sent impulses to both ventricles to coordinate biventricular contraction in the presence of asynchronous contraction due to bundle branch block

Answer 31

Cardiac resynchronization therapy (CRT)

Question 32

Short horizontal lines near periphery of the lung near the costophrenic angles that indicate pulmonary congestion secondary to dilation of pulmonary lymphatic vessels

Answer 32

Kerly B lines

Question 33

Cause of heart failure characterized by impaired filling of the ventricles and decreased ventricular compliance

Answer 33

Diastolic dysfunction

Question 34

The most common cause of diastolic dysfunction

Answer 34

Left ventricular hypertrophy caused by chronic hypertension