Dyspnea (Johnson)

Question 1

What type of HF is associated with inability of ventricle to relax, increased stiffness, decreased compliance, myocardial fibrosis, amyloidosis, acute ischemia, constrictive pericarditis, restrictive cardiomyopathy, SOB, and pulmonary edema?

Answer 1

HFpEF (diastolic HF)

Question 2

What can cause BNP to increase?

Answer 2

HF, AMI, PE, renal failure, old age, pulmonary HTN, severe COPD, ARDS, sepsis

Question 3

What are some non-pharmacologic recommendations for tx of HF?

Answer 3

Proactive immunization against influenza and pneumococcal pneumonia, avoid NSAIDs, reduce slat intake, avoid alcohol, no smoking

Question 4

What should you do if a patient does not want to transfer to a cath lab?

Answer 4

Give fibrinolytic agent (clot buster)

Question 5

What is a major risk factor that increases CVD 2-4 fold?

Answer 5

DM

Question 6

What type of HF is associated with bilateral crackles?

Answer 6

Left HF

Question 7

Which murmur is associated with a “diastolic rumble”?

Answer 7

AI/AR

Question 8

Define dyspnea

Answer 8

Subjective experience of uncomfortable breathing

Question 9

What are some pharmacologic tx for HF?

Answer 9

ACEi/ARBs (contraindicated ni pregnancy, angioedema)
BB (don’t use in unstable, decompensated HF)
Statins
ASA
Nitro
Diuretics
Vasodilators

Question 10

What value of BNP indicates a low likelihood of HF?

Answer 10

<100 pg/mL

Question 11

Describe the ACC/AHA stages of HF

Answer 11

Stage A: no sx, no structural heart dz
Stage B: no sx, structural heart dz
Stage C: heart failure sx, structure heart dz
Stage D: needs surgery, refractory heart failure

Question 12

What is the key diagnostic test for HF?

Answer 12

NONE– it is a clinical dx based on hx and presentation

Question 13

Define HF

Answer 13

Inability of the heart to meet the metabolic demands of the body

Question 14

What type of HF is associated with decreased exercise tolerance, fatigue, orthopnea, PND and S3 gallop?

Answer 14

HFrEF (systolic HF)

Question 15

What is the most common cause of HF?

Answer 15

CAD– IHD

Question 16

What type of HF is associated with tender RUQ?

Answer 16

Right HF

Question 17

Which murmur is associated with an “opening snap”?

Answer 17

MS

Question 18

What is the time frame for getting a patient to the cath lab?

Answer 18

Ideally <90 min

Question 19

What is the most common sx associated with HF?

Answer 19

Dyspnea

Question 20

What are examples of low output HF?

Answer 20

Dilated cardiomyopathy
Valvular dysfunction
Pericardial disease

Question 21

What are examples of high output HF?

Answer 21

Hyperthyroidism
Pregnancy
Anemia
Beriberi
Pagets dz

Question 22

What is the EF in systolic? What about diastolic?

Answer 22

Systolic HF (HFrEF): <40%
Diastolic HF (HFpEF): normal

Question 23

Describe the NYNHA functional classification of HF

Answer 23

Class I: no limitation of PA, asymptomatic
Class II: slight limitation of PA, exertional sx with ordinary activity, no sx at rest
Class III: limitations of PA, no sx at rest
Class IV: unable to carry out physical activities w/o sx, sx at rest