Heart Failure Flashcards
(125 cards)
1
Q
Why is the term “heart failure” preferred over “congestive heart failure”?
A. Because all patients with heart failure exhibit volume overload
B. Because some patients present without signs or symptoms of volume overload
C. Because congestive heart failure only applies to acute cases
D. Because congestive heart failure is only associated with left ventricular failure
A
B
2
Q
ccording to pathophysiologic definitions, heart failure is characterized by:
A. Low blood pressure and elevated intracardiac pressures
B. Elevated cardiac filling pressure and/or inadequate peripheral oxygen delivery due to cardiac dysfunction
C. Reduced ejection fraction without symptom manifestations
D. Structural abnormalities without functional impairments
A
B
3
Q
____ describes patients with longstanding (e.g., months to years) symptoms and/or signs of HF typically treated with medical and device therapy
A
Chronic Heart Failure
4
Q
______, previously termed acute decompensated HF, refers to the rapid onset or worsening of symptoms of HF.
A
Acute Heart Failure
5
Q
____ in HF describes a clinical scenario in which a patient presents with rapidly worsening signs and symptoms of pulmonary congestion, typically due to severe elevation of left heart filling pressure.
A
Acute Pulmonary Edema
6
Q
In the classification of heart failure (HF), an ejection fraction (EF) of ≤40% is referred to as:
A. HF with preserved ejection fraction (HFpEF)
B. Systolic heart failure
C. HF with reduced ejection fraction (HFrEF)
D. Diastolic heart failure
A
C
7
Q
Which of the following ejection fractions (EF) is generally associated with heart failure with preserved ejection fraction (HFpEF)?
A. ≤30%
B. ≤40%
C. 45%
D. ≥50%
A
D
8
Q
In general, prognosis of patients with ____ is superior to that of patients with either HFrEF or HFpEF.
A
HFrecEF
9
Q
____ refers to patients with heart failure and an ejection fraction (EF) between 40% and 50%.
A
HFmrEF
10
Q
In developed countries, ____ is responsible for approximately two-thirds of the cases of HF, with ____ as a principal contributor in up to 75% and ___ in 10–40%
A
Coronary artery disease
HTN
diabetes mellitus
11
Q
In general, adults with CHD who develop HF can be divided into one of three pathophysiologic groups:
A
uncorrected defects with late presentation due to missed diagnosis
nonintervention, or lack of access to care
repaired or palliated defects with late valvular and/or ventricular failure; or failing single-ventricle physiology.
12
Q
In Africa and Asia, ____ remains a major cause of HF, especially in the young.
A
rheumatic heart disease
13
Q
Most forms of familial cardiomyopathy are inherited in an ____ fashion
A
autosomal dominant
13
Q
Ventricular remodeling in heart failure can be categorized into which of the following two patterns?
A. Diastolic hypertrophy and systolic hypertrophy
B. Concentric hypertrophy and eccentric hypertrophy
C. Left and right ventricular hypertrophy
D. Primary hypertrophy and secondary hypertrophy
A
B
14
Q
Which of the following types of ventricular remodeling is typically seen in conditions with pressure overload, such as hypertension and aortic stenosis?
A. Eccentric hypertrophy
B. Right ventricular hypertrophy
C. Concentric hypertrophy
D. Ventricular dilation
A
C
15
Q
Eccentric hypertrophy is primarily associated with which of the following conditions?
A. Aortic regurgitation and mitral regurgitation
B. Pulmonary embolism and systemic hypertension
C. Myocardial infarction and ventricular fibrillation
D. Hypertension and coronary artery disease
A
A
16
Q
At the cellular level, ventricular remodeling in heart failure is often accompanied by which of the following changes?
A. Myocyte atrophy and decreased ventricular mass
B. Myocyte hypertrophy and interstitial fibrosis
C. Increased ejection fraction and reduced wall stress
D. Reduced calcium levels with improved cytoskeletal function
A
B
17
Q
Which of the following is a molecular-level change observed during ventricular remodeling?
A. Improved cytosolic calcium uptake
B. Increased mitochondrial activity
C. Reexpression of fetal genes
D. Enhanced neurohormonal adaptation
A
C
18
Q
The type of cellular death observed in myocytes that are unable to adapt to remodeling stimuli is:
A. Apoptosis or programmed cell death
B. Necrosis exclusively
C. Autophagy
D. Ischemic preconditioning
A
A
19
Q
Which of the following hormones is released primarily from the ventricles in response to increased pressure or stretch?
A. Atrial natriuretic peptide (ANP)
B. Bradykinin
C. B-type natriuretic peptide (BNP)
D. Adrenomedullin
A
B
20
Q
The beneficial actions of natriuretic peptides, such as ANP and BNP, include all of the following EXCEPT:
A. Systemic and pulmonary vasodilation
B. Increased sodium and water excretion
C. Stimulation of renin and aldosterone release
D. Modulation of baroreceptors
A
C
21
Q
Which of the following enzymes inactivates both bradykinin and natriuretic peptides, leading to a rationale for the use of angiotensin receptor–neprilysin inhibitors in heart failure?
A. Guanylate cyclase
B. Neprilysin
C. Aldosterone synthase
D. Renin
A
B
22
Q
The mechanism of action of natriuretic peptides in heart failure involves stimulation of:
A. Protein kinase A
B. Cyclooxygenase
C. Guanylate cyclase
D. Angiotensin-converting enzyme
A
C
23
Q
In heart failure, the upregulation of which of the following hormones provides counterregulatory effects against RAAS and SNS activation?
A. Endothelin
B. Nitric oxide
C. Cortisol
D. Epinephrine
A
B
24
Endothelin is primarily known for which of the following effects in the context of heart failure?
A. Potent vasodilation and anti-inflammatory properties
B. Vasoconstriction and promotion of myocyte hypertrophy
C. Direct renal protective effects
D. Inhibition of pulmonary artery pressure
B
25
Sodium-glucose cotransporter-2 (SGLT-2) is a protein located on the ____ of the kidney that is responsible for reabsorption of up to 90% of filtered glucose.
proximal tubule
26
SGLT-2 activity in HF contributes to:
Sodium and water retention
Endothelial dysfunction
Abnormal myocardial metabolism
Impaired calcium handling
27
What is the primary function of sodium-glucose cotransporter-2 (SGLT-2) in the kidney?
A. Reabsorption of water
B. Filtration of electrolytes
C. Reabsorption of up to 90% of filtered glucose
D. Excretion of metabolic waste products
C
28
In patients with heart failure, activity of SGLT-2 contributes to which of the following?
A. Enhanced myocardial oxygen delivery
B. Sodium and water retention
C. Decreased endothelial dysfunction
D. Improved calcium handling
B
29
Which of the following has been shown in large clinical trials regarding the use of SGLT-2 inhibitors in heart failure patients?
A. They are only safe in patients without diabetes mellitus.
B. They show beneficial effects on morbidity and mortality in HF patients, regardless of diabetes status.
C. They are primarily used for proarrhythmic effects.
D. They solely improve glycemic control with no cardiovascular benefits.
B
30
Which of the following potential mechanisms might explain the beneficial effects of SGLT-2 inhibitors in heart failure?
A. Decreased cardiac and vascular remodeling
B. Increased renal dysfunction
C. Stimulation of RAAS activity
D. Increased myocardial fibrosis
A
31
In up to one-third of patients with heart failure, prolongation of the QRS interval and electrical dyssynchrony can occur. Which form of electrical dyssynchrony is commonly associated with abnormal ventricular contraction?
A. Right bundle branch block (RBBB)
B. Left bundle branch block (LBBB)
C. AV node block
D. First-degree heart block
B
32
Cardiac resynchronization therapy (CRT) is indicated to reduce morbidity and mortality in patients with:
A. Symptomatic HFrEF with LBBB on guideline-directed medical therapy
B. Asymptomatic HFpEF without conduction abnormalities
C. Patients with frequent premature ventricular complexes but normal ejection fraction
D. Pulmonary arterial hypertension without heart failure
A
33
Which of the following mechanisms contributes to secondary mitral regurgitation in heart failure with reduced ejection fraction (HFrEF)?
A. Hyperdynamic left ventricular function
B. Increased dimension of the mitral annulus and inability to contract during systole
C. Thickening of the mitral leaflets
D. Complete atrioventricular block
B
34
What is a potential consequence of atrial fibrillation with inadequate rate control in patients with heart failure?
A. Reduced systemic blood pressure only
B. Improved ventricular contractility
C. Increased wall stress, neurohormonal activation, and inflammation
D. Enhanced left ventricular filling
C
35
Cardiorenal syndrome in heart failure (HF) is traditionally understood as resulting from:
A. Increased cardiac output leading to renal hyperperfusion
B. Impaired forward flow causing reduced renal arterial perfusion and neurohormonal activation
C. Direct myocardial toxicity affecting kidney filtration
D. A decrease in venous return leading to reduced renal functio
B
35
Which of the following has been shown to correlate with an improvement in renal function in heart failure?
A. Increase in preload
B. Relief of systemic venous congestion
C. Increase in afterload
D. Reduction of cardiac contractility
B
36
The splanchnic veins play a crucial role in heart failure by:
A. Triggering systemic vasodilation to reduce preload
B. Acting as a blood reservoir and regulating cardiac preload during volume status changes
C. Stimulating the release of bradykinin to improve renal blood flow
D. Directly influencing heart rate through autonomic feedback
B
37
Which of the following mechanisms can induce renal vasoconstriction in heart failure due to splanchnic congestion?
A. Activation of the splenorenal and hepatorenal reflexes
B. Inhibition of the sympathetic nervous system
C. Increase in cardiac output and forward flow
D. Direct stimulation of myocardial contractility
A
38
What is the combined therapeutic effect of diuretic therapy or mechanical means such as ultrafiltration in the context of heart failure?
A. Only improves cardiac output without affecting abdominal pressure
B. Reduces volume and decreases intraabdominal pressure, improving renal function
C. Enhances left ventricular contractility while increasing abdominal congestion
D. Stimulates neurohormonal activation to promote sodium retention
B
39
Which of the following best describes the hemodynamic profile of a high-output state in heart failure?
A. High cardiac output with elevated systemic vascular resistance (SVR)
B. Low cardiac output with normal SVR
C. High cardiac output with low SVR
D. Low cardiac output with low SVR
C
40
In patients with chronic anemia, what physiological changes contribute to a high-output state with low systemic vascular resistance?
A. Increased blood viscosity and enhanced sympathetic tone
B. Elevated oxygen-carrying capacity and decreased metabolic rate
C. Vasodilatory metabolites and arteriolar vasodilation due to reduced oxygen-carrying capacity, along with decreased blood viscosity
D. Increased hemoglobin synthesis and blood vessel constriction
C
41
Which underlying condition makes patients with end-stage renal disease particularly susceptible to high-output heart failure?
A. Increased afterload due to hypertension
B. Chronic anemia combined with increased flow through an arteriovenous fistula
C. Decreased sympathetic nervous system activation
D. Hypervolemia due to reduced glomerular filtration
B
42
Which of the following is the most common cause of high-output heart failure in contemporary clinical practice?
A. Lung disease
B. Arteriovenous shunts
C. Obesity
D. Myeloproliferative disorders
C
43
What is the pathophysiological mechanism behind orthopnea in heart failure?
A. Increased afterload leading to peripheral resistance
B. Redistribution of fluid from the abdomen and lower body into the chest when lying down
C. Increased systemic vascular resistance during sleep
D. Enhanced cardiac output in the upright position
B
44
Paroxysmal nocturnal dyspnea (PND) differs from orthopnea in that it:
A. Is alleviated by lying flat
B. Occurs predictably after a patient lies down for 1–2 minutes
C. Requires longer for relief and typically awakens the patient from sleep with a sensation of suffocation
D. Is primarily associated with daytime fatigue
C
45
What is the term used to describe the condition involving massive body edema with possible pleural effusions and ascites in patients with advanced right heart failure?
A. Orthopnea
B. Anasarca
C. Cardiac asthma
D. Pulmonary edema
B
46
Nocturia in heart failure patients is most likely due to:
A. Increased renal perfusion when in a supine position
B. Decreased cardiac output during the night
C. High systemic vascular resistance during sleep
D. Acute volume depletion
A
47
In older patients with heart failure and cerebrovascular disease, which of the following symptoms may indicate reduced systemic perfusion?
A. Paroxysmal nocturnal dyspnea
B. Confusion and mental dullness
C. Palpitations and anxiety
D. Syncope and vertigo
B
47
Cardiac cachexia (Table 257-6), defined partially as unintentional edema-free weight loss of ____ over 12 months, may be observed in patients with longstanding, severe HF as bitemporal or upper body muscle wasting.
>5%
47
Which of the following best describes the symptoms associated with right heart failure?
A. Dyspnea at rest and orthopnea
B. Weight gain, lower extremity edema, and gastrointestinal symptoms such as early satiety and bloating
C. Chest pain and syncope
D. Paroxysmal nocturnal dyspnea and frothy sputum
B
48
In patients with chronic HF on guideline-directed medical therapy, resting heart rate ideally should be ____ beats/min, and blood pressure should be in the normal to low-normal range.
<70–75
48
In patients with right heart failure, which rare physical finding may be observed due to severe systemic venous congestion?
A. Facial erythema
B. Scleral icterus and jaundice
C. Cyanotic lips and nails
D. Clubbing of the fingers
B
49
Which of the following findings in a patient with heart failure suggests severe disease?
A. Hypotension and narrow pulse pressure with a rapid, thready pulse
B. Normal blood pressure and normal pulse pressure
C. Elevated blood pressure with a strong, bounding pulse
D. Hypotension with a wide pulse pressure
A
50
Pulsus alternans, an alternatingly strong and weak pulse, is observed in heart failure due to:
A. Variations in heart rate caused by atrial fibrillation
B. Reduced left ventricular contraction in every other cardiac cycle due to incomplete recovery
C. Increased preload with each heartbeat
D. Irregular conduction through the sinoatrial node
B
50
In patients with new-onset heart failure, which of the following vital sign changes is commonly observed?
A. Decreased heart rate and increased blood pressure
B. Increased heart rate and increased blood pressure due to sympathetic activation
C. Normal heart rate and low blood pressure
D. Decreased heart rate and low blood pressure
B
51
In advanced heart failure, a patient may exhibit Cheyne-Stokes respirations, which is best described as:
A. Rapid and shallow breathing without any pauses
B. Periodic breathing with alternating deep and shallow breaths, often associated with apnea
C. Continuous deep, gasping respirations
D. Slow and labored breathing
B
52
Examination of the jugular veins provides an estimate of the ____ pressure.
right atrial
53
____is elicited by applying firm continuous pressure over the liver for 15–30 s while observing the neck veins.
Hepatojugular reflux
54
If significant tricuspid regurgitation is present, prominent If significant tricuspid regurgitation is present, prominent V waves and Y descents may be noted __ waves and ___ descents may be noted.
V
Y
55
In a patient with mild right heart failure, which of the following is most likely to be observed at rest regarding jugular venous pressure (JVP)?
A. Normal JVP (≤8 cmH₂O)
B. Elevated JVP reaching the angle of the jaw
C. Rapidly increasing JVP with deep inspiration
D. Significantly elevated JVP with large V waves at rest
A
56
Which of the following describes the procedure and purpose of the hepatojugular reflux test?
A. The patient strains during the maneuver to elevate JVP for 10 seconds
B. Firm pressure is applied over the liver for 15–30 seconds while observing the neck veins, used to assess right heart function
C. The patient is positioned upright, and the JVP is measured at the angle of the jaw
D. The patient exhales forcefully to assess venous return to the heart
B
57
A prominent V wave and Y descent in the JVP waveform is commonly associated with which condition in a patient with heart failure?
A. Constrictive pericarditis
B. Severe tricuspid regurgitation
C. Left ventricular hypertrophy
D. Pulmonary hypertension
B
58
The presence of Kussmaul's sign in a heart failure patient is characterized by:
A. A drop in JVP with inspiration
B. An increase in JVP with inspiration
C. Absence of a visible JVP wave
D. Decreased JVP with hepatic compression
B
59
An abdominojugular test that shows an increase in JVP during midabdominal compression followed by an abrupt drop on release suggests:
A. Normal cardiac function
B. Elevated left-sided filling pressures
C. Right atrial hypovolemia
D. Low systemic vascular resistance
B
60
Pulmonary rales in a patient with heart failure are most commonly caused by:
A. Airway obstruction
B. Transudation of fluid into the alveoli and airways
C. Bronchospasm due to reactive airways disease
D. Pulmonary embolism
B
61
In patients with longstanding heart failure and chronically elevated pulmonary capillary wedge pressures, pulmonary rales may be absent due to:
A. Reduced cardiac output
B. Increased lymphatic drainage preventing fluid accumulation in the alveoli
C. Low oxygen saturation at rest
D. Increased systemic vascular resistance
B
62
In patients with heart failure, an S3 gallop on auscultation is most commonly associated with:
A. Volume overload and tachycardia, indicating severe hemodynamic compromise
B. Pulmonary embolism
C. Mild left ventricular dysfunction
D. Diastolic dysfunction in the absence of any volume overload
A
63
On auscultation, an ___ gallop is most commonly present in patients with volume overload and tachycardia, suggests severe hemodynamic compromise, and carries negative prognostic significance.
S 3
64
____ murmurs of mitral and tricuspid regurgitation are present in the setting of advanced HF, often in the absence of structural valvular abnormalities.
Holosystolic
65
Hepatomegaly in heart failure is primarily caused by:
A. Increased cardiac output
B. Systemic venous congestion
C. Pulmonary venous congestion
D. Left ventricular hypertrophy
B
66
In patients with chronic heart failure, lower extremity edema is typically:
A. Unilateral and nonpitting
B. Symmetric and pitting
C. Dependent and nonpitting
D. Localized only to the sacral area
B
67
Nonpitting edema that does not respond to increasing doses of diuretics in a patient with heart failure is likely due to:
A. Lymphedema
B. Systemic venous congestion
C. Anasarca from severe heart failure
D. Bilateral deep venous thrombosis
A
68
Which laboratory test is often elevated in moderate to severe heart failure due to reduced renal blood flow and/or increased renal venous pressure?
A. Sodium
B. Blood urea nitrogen (BUN) and creatinine
C. Hemoglobin
D. Glucose
B
69
A modest elevation in transaminases, alkaline phosphatase, and bilirubin in a heart failure patient is most likely due to:
A. Renal failure
B. Congestive hepatomegaly from chronic right heart failure
C. Acute coronary syndrome
D. Hyperthyroidism
B
70
A marked elevation in transaminases and lactic acid in a patient with heart failure suggests:
A. Pulmonary embolism
B. Cardiogenic shock with severe low output
C. Chronic kidney disease
D. Hypertensive emergency
B
71
Which of the following electrolyte abnormalities is most commonly seen in heart failure patients due to sodium restriction, diuretic therapy, and vasopressin-mediated water retention?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypercalcemia
C
72
Hypokalemia in heart failure patients is most often caused by:
A. RAAS inhibitors without potassium supplementation
B. Thiazide or loop diuretics without potassium supplementation
C. Potassium-sparing diuretics
D. High dietary potassium intake
B
73
Which of the following conditions may cause hyperkalemia in heart failure patients?
A. Use of thiazide diuretics alone
B. Reduced glomerular filtration rate and use of RAAS inhibitors and potassium-sparing diuretics
C. High fluid intake
D. Use of loop diuretics without potassium supplementation
B
74
Iron deficiency in heart failure patients has been attributed to:
A. Increased appetite and food intake
B. Decreased gut absorption, impaired hepatic storage, and chronic blood loss
C. Increased iron absorption in the gut
D. Low oxygen saturation
C
75
Major abnormalities on chest imaging associated with left HF include enlarged cardiac silhouette (cardiothoracic ratio ___) and ____.
>0.5
pulmonary venous congestion
76
Early radiologic signs of acute HF include ____ and thickening of interlobular septa.
upper zone venous redistribution
77
Which of the following findings on chest X-ray is most indicative of left heart failure?
A. Enlarged cardiac silhouette with cardiothoracic ratio >0.5 and pulmonary venous congestion
B. Hyperinflated lungs with a flattened diaphragm
C. Patchy infiltrates in the lower lung fields
D. Cavitary lesions
A
78
Alveolar edema on a chest X-ray in a heart failure patient typically appears as:
A. Unilateral consolidation
B. Diffuse haziness extending toward the lower lung fields
C. Cystic lesions in the upper lobes
D. Pneumothorax
C
79
The presence of left ventricular hypertrophy and left atrial enlargement on ECG in a patient with heart failure is most suggestive of:
A. Dilated cardiomyopathy
B. Cardiac amyloidosis
C. HFpEF due to hypertension, aortic stenosis, or hypertrophic cardiomyopathy
D. Acute myocardial infarction
C
80
____is indicated to rule out atrial thrombi prior to cardioversion and can assess aortic or mitral valve pathology in planning for transcatheter valvular replacement or repair.
Transesophageal echocardiogram
81
82
Cardiac positron emission tomography (PET) is particularly useful in evaluating:
A. Bone metastases in heart failure patients
B. Extent of ischemia or infarction in coronary artery disease and assessing cardiac inflammation in sarcoidosis
C. Pulmonary edema in left heart failure
D. Pericardial thickness
B
83
In patients with heart failure, which factor may lead to falsely low levels of natriuretic peptides, potentially complicating diagnosis?
A. Hypertension
B. Obesity
C. Atrial fibrillation
D. Advanced age
B
84
____ and soluble ___ are newer biomarkers that have been approved for assessment of prognosis in HF but are not widely used.
Galectin-3
ST2
85
Which class of glucose-lowering medications has been shown to be safe in heart failure patients and can improve renal function and reduce the risk of hospitalization and death?
A. Sulfonylureas
B. Insulin
C. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors
D. Thiazolidinediones
C
86
The "obesity paradox" in heart failure refers to the observation that:
A. Obese patients with HF have a worse prognosis compared to those with a normal BMI
B. Weight loss in HF always improves survival
C. Obese patients with HF have a more favorable prognosis compared to those with low or normal BMI
D. Obesity decreases the incidence of HF
C
87
Continuous positive airway pressure (CPAP) therapy in patients with heart failure and obstructive sleep apnea has been shown to:
A. Have no effect on blood pressure
B. Worsen quality of life
C. Improve quality of life, decrease blood pressure and arrhythmias, and increase ejection fraction
D. Cause adverse effects in most patients
C
88
Which of the following is true regarding therapy for central sleep apnea in heart failure?
A. No proven therapy exists, though the role of nocturnal oxygen is being evaluated
B. CPAP is the recommended treatment
C. Surgical intervention is often required
D. Bronchodilators are effective
A
89
Laboratory Parameters Associated with Poor Prognosis:
Blood urea nitrogen (BUN) ____ mg/dL.
Systolic blood pressure ___ mmHg.
Serum creatinine ___ mg/dL.
Elevated cardiac biomarkers: Natriuretic peptides and cardiac troponins indicate a higher risk of adverse outcomes.
>43
<115
>2.75
90
Meta-analyses suggest a 23% reduction in mortality and a 35% reduction in the combined endpoint of mortality and hospitalizations for HF in patients with symptomatic HFrEF treated with ____
ACE inhibitors
91
Addition of _____ to background therapy with ACEIs provides a further 35% reduction in mortality.
β-adrenergic receptor blockers
92
____ is a suitable alternative for patients who are intolerant to ACEIs due to cough or angioedema.
ARBs
93
Beta blocker use in HFrEF should ideally be restricted to ____, _____, and ______ —agents tested and proven to improve survival in clinical trials.
carvedilol
bisoprolol
metoprolol succinate
94
Prospective trials of high- versus low-dose ACEIs (ATLAS), ARBs (HEAAL), and beta blockers (MOCHA) consistently favor the ____ dose, with lower rates of death and HF hospitalization seen in the ____-dose group.
higher
higher
95
____ is the most commonly utilized agent in this class based on efficacy demonstrated in the Randomized Aldactone Evaluation Study (RALES) in patients with HFrEF and NYHA class III–IV symptoms.
Spironolactone
96
_____ (studied principally in patients with milder NYHA class II symptoms and those with HF or left ventricular dysfunction complication myocardial infarction) lacks the antiandrogen effects of spironolactone and may be a suitable alternative for patients who experience sexual side effects (gynecomastia, erectile dysfunction, diminished libido).
Eplerenone
97
Angiotensin II can be generated by non-ACE pathways, levels of angiotensin II may recover to pretreatment levels during long-term ACEI therapy. This phenomenon is called ____
neurohormonal “escape”
98
T/F
Guidelines discourage the combination of an ACEI, ARB, and spironolactone in HFrEF due to the risks of hyperkalemia and renal dysfunction, and for most patients, treatment with either an ACEI or ARB and spironolactone is appropriate.
T
99
Given ongoing concern for angioedema, use of ARNI is contraindicated in patients with prior history of _____, and those being transitioned from ACEIs should receive ARNI only after a ____-hour gap to limit the risk of overlap.
angioedema
36
100
Consider ____ in HFrEF patients who:
Remain symptomatic despite treatment with guideline-based therapy (ACEI/ARB/ARNI, beta blockers, and MRAs).
Are in sinus rhythm with a resting heart rate >70 bpm.
ivabradine
101
Second-generation calcium channel blocking agents, safely and effectively reduce blood pressure in HFrEF but do not affect morbidity, mortality, or QOL.
Amlodipine
Felodipine
102
A 68-year-old man with a history of nonischemic heart failure with reduced ejection fraction (HFrEF) is enrolled in a clinical trial targeting inflammatory cytokines. Which of the following outcomes has been observed in trials targeting tumor necrosis factor-α (TNF-α) in HF patients?
A. Reduced HF hospitalizations
B. Improvement in left ventricular ejection fraction
C. Increased risk of worsening HF
D. Reduction in inflammatory markers with improved survival
C
103
Which of the following therapies targeting inflammation in heart failure has shown a dose-dependent reduction in HF hospitalizations and mortality in patients with post-myocardial infarction and elevated high-sensitivity C-reactive protein?
A. Intravenous immunoglobulin therapy
B. Canakinumab (IL-1β monoclonal antibody)
C. Infliximab (TNF-α inhibitor)
D. Nonspecific immunomodulation
B
104
Which of the following describes the hypothesis underlying nonspecific immunomodulation therapy for heart failure?
A. Suppression of TNF-α using a monoclonal antibody
B. Reducing inflammatory cytokine production by inducing apoptosis of leukocytes
C. Augmenting interleukin-1β activity to enhance anti-inflammatory responses
D. Decreasing oxidative stress using intravenous antioxidants
B
105
Which of the following describes the role of statins in the management of patients with established heart failure with reduced ejection fraction (HFrEF)?
A. Statins improve mortality in patients with nonischemic HFrEF.
B. Statins reduce the need for diuretic therapy in HFrEF.
C. Statins do not improve aggregate clinical outcomes in established HFrEF.
D. Statins improve exercise tolerance and quality of life in HFrEF.
C
106
In the CORONA and GISSI-HF trials evaluating low-dose rosuvastatin in patients with HFrEF, what was the observed outcome?
A. Significant improvement in cardiovascular survival and reduced hospitalizations
B. No significant improvement in clinical outcomes
C. Increased risk of adverse events related to statin use
D. Improved quality of life and exercise tolerance
B
107
In which scenario is the use of statins most appropriate for a patient with heart failure?
A. Routine use in patients with nonischemic HFrEF
B. Treatment of progressive atherosclerotic vascular disease in HF patients
C. Prevention of ventricular remodeling in ischemic cardiomyopathy
D. Reduction in myocardial fibrosis in nonischemic HF
B
108
What was the primary finding regarding omega-3 polyunsaturated fatty acids (w-3 PUFAs) in the GISSI-HF trial?
A. Omega-3 PUFAs reduced all-cause mortality and improved left ventricular ejection fraction (LVEF).
B. Omega-3 PUFAs were associated with modest improvements in clinical outcomes in patients with HFrEF.
C. Omega-3 PUFAs showed no benefit in heart failure with reduced ejection fraction (HFrEF).
D. Omega-3 PUFAs were associated with increased hospitalization rates in patients with HFrEF.
B
109
What is the relationship between low baseline eicosapentaenoic acid (EPA) levels and outcomes in patients with HFrEF?
A. Low EPA levels are associated with improved exercise tolerance.
B. Low EPA levels are inversely related to total mortality.
C. Low EPA levels are directly correlated with better QOL scores.
D. Low EPA levels are inversely related to total mortality in patients with HFrEF.
D
110
Which of the following statements regarding micronutrients in heart failure is correct?
A. Routine supplementation with thiamine is recommended in all patients with HFrEF.
B. Thiamine deficiency may result in reversible heart failure but is primarily associated with acute decompensated heart failure (ADHF).
C. Severe deficiencies of selenium or thiamine can lead to reversible heart failure.
D. Thiamine and selenium supplementation improve survival in patients with ADHF.
C
111
What is the current recommendation regarding thiamine supplementation in patients with HFrEF?
A. Routine thiamine supplementation is recommended for all patients with chronic HFrEF.
B. Routine thiamine supplementation is not recommended due to limited evidence.
C. Thiamine supplementation is effective for treating acute decompensated HF (ADHF).
D. Thiamine supplementation should only be administered in conjunction with iron therapy.
B
112
What was the maximum improvement in 6-minute walk distance observed during the HF-ACTION trial?
A. At 1 month.
B. At 3 months.
C. At 6 months.
D. At 12 months.
B
113
What long-term benefits were observed with exercise training in the HF-ACTION trial for patients with moderate HFrEF?
A. Significant mortality reduction and decreased HF hospitalizations.
B. Decreased reliance on pharmacologic therapy.
C. No significant improvements beyond the short-term gains.
D. Improvements in peak oxygen consumption and cardiopulmonary exercise time.
D
114
The single most important association of extent of dyssynchrony is a ____ QRS interval on the surface electrocardiogram, particularly in the presence of a ____ pattern.
widened
LBBB
115
____ due to ventricular arrhythmias is the mode of death in approximately half of patients with HF and is particularly proportionally prevalent in HFrEF patients with early stages of the disease.
Sudden cardiac death (SCD)
115
Most benefit in mildly symptomatic HFrEF patients accrues from applying this therapy in those with a QRS width of >149 ms and a left bundle branch block pattern.
116
A 62-year-old male with ischemic cardiomyopathy and a left ventricular ejection fraction (LVEF) of 30% has NYHA Class III heart failure symptoms despite optimal medical therapy. Which of the following is the most appropriate next step to reduce the risk of sudden cardiac death (SCD)?
A) Implantable cardioverter-defibrillator (ICD)
B) Cardiac resynchronization therapy (CRT) without ICD
C) Ablation of ventricular arrhythmias
D) Initiation of amiodarone therapy
E) Referral for heart transplantation
A
117
In which of the following patients is prophylactic implantation of an ICD least likely to reduce mortality from sudden cardiac death?
A) A 45-year-old male with non-ischemic cardiomyopathy, NYHA Class III symptoms, and LVEF of 25%
B) A 60-year-old female with prior myocardial infarction, LVEF 28%, and asymptomatic NYHA Class I status
C) A 55-year-old male with ischemic cardiomyopathy, LVEF 30%, and NYHA Class II symptoms
D) A 75-year-old male with terminal cancer and a predicted life expectancy of 6 months
E) A 50-year-old female with prior ventricular fibrillation and LVEF 40%
D
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