Heart Failure (Johnston)

Question 1

The most common cause of LV systolic dysfunction is from ___

Answer 1

Ischemic heart disease

Question 2

This stage of heart failure is characterized by having HF risk factors, no heart disease, and no symptoms

Answer 2

A

Question 3

This stage of heart failure is characterized by having heart disease, no symptoms, can have LV dysfunction

Answer 3

B

Question 4

This stage of HF is characterized by a pt who has prior or current HF symptoms with structural heart disease

Answer 4

C

Question 5

This stage of HF is characterized by refractory HF. These pts are eligible for mechanical support, transplants and have 1 year mortality of 50-60%

Answer 5

D

Question 6

Which NYHA class is characterized by an inability to carry out physical activity without discomfort and has a 1 year mortality of 50-60%?

Answer 6

IV

The only class of NYHA that has symptoms at rest

Question 7

This type of HF accounts for at least 50% of cases and includes decreased SV, increased ventricle filling pressure and the EF is less than 40%. You get Hypoperfusion with impaired ventricular filling. These pts are weak, fatigued, and have reduced exercise intolerance

Answer 7

Systolic HF

Question 8

Pts with this type of HF have a normal EF, SOB, DOE, pulmonary edema, and an inability of the LV to relax/fill. There is an increased resistance to ventricular filling and decreased compliance or increased stiffness.

Answer 8

Diastolic HF

I.e., restrictive/constrictive pericarditis, hypertensive/hypertrophic cardiomyopathy

Question 9

Hyperthyroidism, anemia, pregnancy, AV fistula, beriberi, Pagets are associated with this type of HF

Answer 9

High output –> High CO but low EF

Question 10

Ischemic heart disease, HTN, dilated cardiomyopathy, valvular and pericardial disease are associated with this type of HF

Answer 10

Low output

Question 11

Pulm HTN d/t pulm embolus, edema, hepatomegaly, and venous distention are signs of ___

Answer 11

Right sided HF

Question 12

Aortic stenosis, Mitral insufficiency, dyspnea, orthopnea are signs/symtpoms of ___

Answer 12

Left sided HF

Question 13

What are some meds that can worsen HF?

Answer 13

CCB
B blockers
NSAID
Antiarrhythmics

Question 14

The presence of this sign increases the likelihood of HF 11-fold:

Answer 14

Presence of S3 gallop

Question 15

What are signs/symptoms of RV failure?

Answer 15

Peripheral/sacral edema
Hepatomegaly
Ascites
Increased JVD, HJR

Question 16

What electrolyte imbalances will you see on CMP as well as the BUN to Cr ratio in a pt with HF?

Answer 16

Low Na, K

Pre-renal azotemia –> High BUN:CR

Question 17

If a pt is in HF, greater than 65 years old with A FIb, what do you want to check?

Answer 17

Thyroid –> Free T4, TSH

Question 18

What are some indications for admission to the hospital for management of HF?

Answer 18

Acute myocardial ischemia
Severe RD
Hypoxia
Hypotension
Cardiogenic shock
Anasarca
Syncope
HF refractory to oral meds

Question 19

This drug is useful for all NYHA functional classifications with systolic HF, lower mortality and morbidity by 20%, is useful in preventing HF in high-risk pts (ASHD, MD, HT) level of evidence=A, and recommended in pts with symptoms of HF, reduced EF, unless contraindicated with Level of Evidence=A

Answer 19

ACEi’s

Question 20

When should you use ACEi’s cautiously and when are they contraindicated?

Answer 20

Use cautiously with renal insufficiency (Cr greater than 2.5 mg) or K greater than 5

Contraindicated in angioedema, pregnancy, bilateral renal a stenosis

Side effect is the ACEi cough

Question 21

This drug is comparable to the ACEi but not more effective and shouldn’t be given to pt if they had angioedema from ACEi

Answer 21

ARBs

Question 22

This drug is recommended for all stable pts with symptoms of HF, reduced EF, unless contraindicated with a level of evidence=A. Use these in pts with NYHA class II and III but not IV

Answer 22

B blockers

Question 23

This inotropic agent improves the quality of life associated with HF but no demonstrable effect on survival. It inhibits Na/K ATPase and increases contractile state by increasing IC Ca concentration. It is useful in a fib to slow ventricular rate

Answer 23

Digitalis-Lanoxin

Question 24

What electrolyte do you need to monitor if you give a HF pt spironolactone?

Answer 24

K

Question 25

A systolic murmur that radiates into the left axilla is likely:

Answer 25

Mitral regurgitation

Question 26

This intotrope increases contractility by stimulating beta 1 and beta2 receptors

Answer 26

Dobutamine

Question 27

This drug for HF is an arterial vasodilator, reduces afterload and SVR

Answer 27

Hydralazine

Question 28

This drug type is a veno-vasodilator and reduces preload or reduce venous return to increase CO

Answer 28

Nitrates

Question 29

What drug combo should be considered in african americans than in whites considering HF?

Answer 29

Hydralazine and isosorbide di/mononitrates

Question 30

This drug class is a tx for pts with HF associated with reduced EF but is not recommended as routine and provides no benefit

Answer 30

CCBs

Question 31

What OMM techniques can be utilized in HF lymph tx?

Answer 31

Open thoracic inlet Rib raising Diaphragm doming Effleurage/petrissage

Question 32

What is the dominant etiology of heart failure?

Answer 32

CAD-Ischemic heart disease (60-75%)