Final: 24 Apr Heart Failure '25

Question 1

What is Heart Failure (HF)?

Answer 1

HF is a complex syndrome leading to impaired ventricular filling or blood ejection

HF may be caused by structural abnormalities of the pericardium, myocardium, endocardium, heart valves, or great vessels.

Question 2

What are common symptoms of Heart Failure?

Answer 2

Fatigue, dyspnea, weakness, edema, and weight gain.

Question 3

What characterizes HF with reduced ejection fraction (HFrEF)?

Answer 3

HF with EF ≤ 40%.

Question 4

What characterizes HF with preserved ejection fraction (HFpEF)?

Answer 4

HF with EF ≥ 50%.

Question 5

What is ‘borderline HFpEF’?

Answer 5

Symptomatic HF with an EF between 40-49%.

Question 6

What is the main marker for determining HF risk factors, treatment, and outcomes?

Answer 6

Ejection fraction, measured on echocardiogram.

Question 7

What proportion of HF patients have a normal ejection fraction?

Answer 7

Approximately 1/2 of HF patients have normal (>50%) ejection fraction.

Question 8

What conditions are associated with the increasing proportion of HFpEF?

Answer 8

• Hypertension (HTN)
• Diabetes Mellitus (DM)
• Atrial fibrillation (A-fib)
• Obesity
• Metabolic syndrome
• Chronic obstructive pulmonary disease (COPD)
• Renal insufficiency
• Anemia.

Question 9

Which gender is more likely to be affected by HFpEF?

Answer 9

Women.

Question 10

Which gender is more likely to be affected by HFrEF?

Answer 10

Men.

Question 11

What is the primary determinant of HFpEF?

Answer 11

Left ventricular diastolic dysfunction (LVDD).

Question 12

What is the primary determinant for HFrEF?

Answer 12

Left ventricular systolic dysfunction (LVSD).

Question 13

What factors determine the left ventricle’s ability to fill?

Answer 13

• Pulmonary venous blood flow
• Left atrial (LA) function
• Mitral valve dynamics
• Pericardial restraint
• Elastic properties of the left ventricle.

Question 14

What does a steeper rise of the end-diastolic pressure-volume curve indicate?

Answer 14

Delayed left ventricular relaxation and increased myocardial stiffness.

Question 15

What common symptoms are associated with HFpEF?

Answer 15

Paroxysmal nocturnal dyspnea, pulmonary edema, dependent edema.

Question 16

What common symptoms are more prevalent in HFrEF?

Answer 16

S3 gallop.

Question 17

What is the ACC/AHA diagnostic criteria for HFpEF?

Answer 17

HF symptoms, EF > 50%, and evidence of LVDD.

Question 18

What role do biomarkers like BNP and N-terminal pro-BNP play in HF?

Answer 18

They are important biomarkers related to LV end-diastolic wall stress.

Question 19

What is the mainstay treatment for HFrEF?

Answer 19

Beta-blockers and ACE-inhibitors.

Question 20

What treatment is recommended for managing symptoms in HFpEF?

Answer 20

Mitigation of symptoms, treatment of associated conditions, exercise, and weight loss.

Question 21

What surgical procedure can reverse LV dysfunction after myocardial infarction?

Answer 21

Coronary revascularization via CABG or PCI.

Question 22

What is the purpose of cardiac resynchronization therapy (CRT)?

Answer 22

To treat HF with a ventricular conduction delay (prolonged QRS).

Question 23

What is the function of an intra-aortic balloon pump (IABP)?

Answer 23

Improves left ventricular coronary perfusion by reducing LVEDP.

Question 24

What is the primary goal of surgical treatment for chronic HF?

Answer 24

To prevent ventricular remodeling and preserve natural geometry of the heart.

Question 25

What characterizes acute heart failure?

Answer 25

Rapid onset, often presenting with life-threatening conditions.

Question 26

What is the first-line treatment for acute decompensated heart failure (ADHF)?

Answer 26

Diuretics.

Question 27

What are positive inotropes used for in acute heart failure treatment?

Answer 27

To manage acute reduced contractility or cardiogenic shock.

Question 28

What is the role of exogenous BNP (Nesiritide) in acute heart failure?

Answer 28

Inhibits the RAAS and promotes vasodilation, decreasing LVEDP and improving dyspnea.

Question 29

What is the definition of chronic heart failure?

Answer 29

Long-standing HF disease.

Question 30

What is the difference between de novo acute heart failure and acute decompensated heart failure?

Answer 30

De novo AHF has a sudden increase in filling pressures or acute myocardial dysfunction, while ADHF exacerbates preexisting HF.

Question 31

What is the significance of elevated mean pulmonary capillary wedge pressure in HFpEF?

Answer 31

Indicates HFpEF and is a predictor of mortality.

Question 32

What is the association between HFpEF and inflammation?

Answer 32

C-reactive protein (CRP) and Growth differentiation factor-15 (GDF15) represent the inflammatory component of HF.

Question 33

What is the purpose of a miniature rotary blood pump in heart failure treatment?

Answer 33

To draw blood continuously from the left ventricle and eject it into the ascending aorta ## Footnote This device serves as a bridge to recovery or cardiac procedures.

Question 34

What does AHF stand for in the context of surgical treatment?

Answer 34

Acute Heart Failure ## Footnote AHF requires specific surgical interventions for management.

Question 35

What are the two types of Ventricular Assist Devices (VAD)?

Answer 35

* Peripheral VAD * Central VAD/ECMO

Question 36

What is a key benefit of Central VAD/ECMO?

Answer 36

Complete ventricular decompression and avoidance of limb impairment ## Footnote It also helps prevent superior vena cava syndrome.

Question 37

True or False: Patients on ECMO have improved lung perfusion.

Answer 37

False ## Footnote Blood bypasses the lungs, leading to reduced lung perfusion.

Question 38

What is Hypertrophic Cardiomyopathy (HCM)?

Answer 38

A complex primary cardiomyopathy characterized by left ventricular hypertrophy in the absence of other causes ## Footnote HCM is the most common genetic cardiovascular disease.

Question 39

What are common EKG abnormalities in patients with HCM?

Answer 39

* High QRS voltage * ST-segment and T-wave alterations * Abnormal Q waves * Left atrial enlargement

Question 40

What is the primary medical treatment for Hypertrophic Cardiomyopathy?

Answer 40

* Beta-blockers (BBs) * Calcium channel blockers (CCBs) ## Footnote Disopyramide may also be considered as an add-on therapy.

Question 41

What is the most common initial symptom of Dilated Cardiomyopathy?

Answer 41

Heart failure ## Footnote Chest pain may also occur.

Question 42

What characterizes Stress Cardiomyopathy?

Answer 42

Left ventricular hypokinesis with ischemic EKG changes despite patent coronary arteries ## Footnote It is often triggered by physical or emotional stress.

Question 43

What are the criteria for diagnosing Peripartum Cardiomyopathy?

Answer 43

* Development of peripartum heart failure * Absence of another explainable cause * Left ventricular systolic dysfunction with EF < 45%

Question 44

What is Cor Pulmonale?

Answer 44

Right ventricular enlargement that may progress to right heart failure ## Footnote It is commonly caused by pulmonary hypertension.

Question 45

What is the most important determinant of pulmonary hypertension in patients with chronic lung disease?

Answer 45

Alveolar hypoxia ## Footnote This condition can lead to Cor Pulmonale.

Question 46

Fill in the blank: Hypertrophic cardiomyopathy (HCM) is the most common ________ cardiac disorder.

Answer 46

genetic

Question 47

What is the principal indication for cardiac transplant?

Answer 47

Dilated cardiomyopathy ## Footnote It is the most common form of cardiomyopathy.

Question 48

What are the common dysrhythmias associated with Dilated Cardiomyopathy?

Answer 48

* Premature Ventricular Contractions (PVC) * Atrial fibrillation (Afib)

Question 49

What surgical strategies are used for Hypertrophic Cardiomyopathy?

Answer 49

* Septal myomectomy * Cardiac catheterization with injection for ischemia * Echocardiogram-guided percutaneous septal ablation * Prosthetic mitral valve insertion

Question 50

What is the recommended preoperative management for heart failure patients?

Answer 50

Comprehensive preoperative exam to determine compensation status ## Footnote Conditions like hypertension, diabetes, angina, and renal failure should be optimized.

Question 51

What medications are typically held on the day of surgery for heart failure patients?

Answer 51

Diuretics ## Footnote Maintenance of beta-blockers is essential.

Question 52

What is the role of an implantable cardioverter-defibrillator (ICD) in HCM?

Answer 52

Primary treatment for patients at risk of sudden cardiac death due to dysrhythmias

Question 53

What is the significance of the ejection fraction in HCM?

Answer 53

Usually > 80%, reflecting hypercontractility; may become depressed in severe cases

Question 54

What are the common causes of secondary cardiomyopathy?

Answer 54

* Amyloidosis * Hemochromatosis * Sarcoidosis * Carcinoid tumors