Chf

Question 0

Acei

Hope study

Answer 0

Cad
OCD
Stroke
DM with another risk factor 
DM with smoking or micro albuminuria

Question 1

Early satiety is a sign of

Answer 1

Right heart failure

Question 2

Beta blockers

Answer 2

People with prior mi
Reduce mortality
Prevent recurrent mi
Prevent CHF

Question 3

CHF increase mortality

Answer 3

With elevated JVD and S3

Question 4

Bnp

Answer 4

Not for routine screening
> 500 high PPV
<100 high negative predictive valuey
Obesity low bnp

Question 5

Peak VO2

Answer 5

Less than 14 is tranplant candidate
Betablockers reduce VO2 but increase survival
Breathing reserve normal value is 30%

Question 6

Myocardial biopsy

Answer 6

Rapidly worsening CHF
Amyloidodis
Malignant arrhythmias if you suspect sarcoidosis or giant cell myocarditis

Question 7

CHF

Answer 7

Do not routinely combine acei and ARB

Betablockers for asptomatic patients with low EF

Question 8

Coreg

Answer 8

Dose dependent effect
Max benifit only with 25 mg bid
Max all meds

Question 9

Aldosterone in CHF

Answer 9

Increased 20 times normal in CHF
Rales study shows benifit
But needs to be on acei first
Eplerinone which is an Aldo blocker in emphasis trial shows improved survival

Question 10

Hydralazine/ nitro in CHF

Answer 10

A heft trial
Class 1-4 in blacks
In non blacks who has symptoms despite max meds

Question 11

Diuretics

Answer 11

Failure usually due to non compliance
Renal failure
Low cardiac out out
Loop diuretics are better

Question 12

Loop diuretics

Answer 12

Ethycrinic acid no sulfa

Bumex and torsemide are better when lasix fails and in right heart failure

Question 13

Dig

Answer 13

Keep level below 1

No survival benifit in CHF only symptom

Question 14

CHF adjuvant

Answer 14

Pneumonia vaccine
Flu vaccine
Sleep apnea
Ssri better than tricyclics

Question 15

Heart failure with normal EF

Answer 15

Elderly females
HTN 
DM
Obesity
Cad no previous mi
Survival same as with CHF with reduced EF

Question 16

Bnp

Answer 16

High in both types of CHF

30% reduction necessary before DC

Question 17

Echo

Answer 17

Mitral flow do valsalva

Question 18

CHF with pedal edema and dyspnea is diastolic CHF

Answer 18

Hfpef no treatment works

Question 19

CHF rehospitaluzation

Answer 19

Death usually in one year

Question 20

Aldactone dose

Answer 20

Start 50 mg

Question 21

Cold and dry use ionotrophs

Answer 21

Cold and wet use nipride and nitro

Avoid lasix it may drop your EF

Question 22

CHF

Answer 22

Hypoxia is rare

Question 23

MR surgery

Answer 23

Do not fix if the LV is dilated

Question 24

Indications of transplant

Answer 24

Intractable CHF Uncontrolled angina Uncontrollable VT

Question 25

People with low EF

Answer 25

Surgery is better than medical therapy in one vessel, Two vessel and three vessel disease

Question 26

Stitch trial

Answer 26

Viability is useless Remodeling useless Lima is needed for survival benifit

Question 27

Gorlin formula

Answer 27

Is not accurate in low EF so recheck the valve area with dibutamine

Question 28

Regurgitant lesions

Answer 28

Operate early | Steno tic lesion do poorly with anesthesia

Question 29

Lone tricuspid repair

Answer 29

``` Class 2 severe tr No class 1 ```

Question 30

Icd primary prevention

Answer 30

40 days to implant

Question 31

Transplant prognosis

Answer 31

Thrombocytopenia and hypo albuminemia are bad signs 11 year survival 50% Statins improve survival

Question 32

Side effects

Answer 32

Cyclosporine rf HTN gingival hyperplasia | Mycophenolate GI neutropenia

Question 33

Post transplant

Answer 33

Weekly biopsies for 4 weeks | Every other week for 2 then taper off

Question 34

Rejection

Answer 34

``` Hyper acute Cellular Humoral 0 no infiltrate 1a focal 1b diffuse but sparse 2 one focus 3a multi focal with necrosis 3b diffuse with necrosis 4 severe diffuse hemorrhagic ```

Question 35

Humoral

Answer 35

Ivg and plasma pheresis

Question 36

Post transplant cad

Answer 36

No angina

Question 37

Infection

Answer 37

Cmv Fungal Pcp prophylaxis

Question 38

Adenosine

Answer 38

Effect is unpredictable in transplant patients

Question 39

Breathing reserve

Answer 39

30 is normal | 35 and above is bad

Question 40

Transplant

Answer 40

``` Vt VF mean rejection Svt humoral rejection RBBB due to biopsies Heart block Sinus tachy at the base line ```

Question 41

Heart mate

Answer 41

Continuous flow is better than pulse

Question 42

Transplant RV functions

Answer 42

RV stroke work index >300 | Cvp<4 wood units

Question 43

Transplant

Answer 43

Statins Statins Statins

Question 44

Transplant renal insufficiency

Answer 44

Try | Basiliximab as a bridge

Question 45

Prevalence 1-2% 40-59 years | 12% older than 80

Answer 45

20% new cases a year

Question 46

Statins no benifit in CHF

Answer 46

Corona study

Question 47

Dibutamine

Answer 47

23% people treated may develop eosinophilia myocarditis

Question 48

CHF

Answer 48

Avoid nonsteroidals