Heart failure

Heart failure US Medical PG Question 1: An 18-year-old man presents to a rural emergency department after being stabbed multiple times. The patient's past medical history is notable for obesity, diabetes, chronic upper respiratory infections, a 10 pack-year smoking history, and heart failure. He is protecting his airway and he is oxygenating and ventilating well. His temperature is 97.6°F (36.4°C), blood pressure is 74/34 mmHg, pulse is 180/min, respirations are 24/min, and oxygen saturation is 98% on room air. The patient is started on whole blood and the surgeon on call is contacted to take the patient to the operating room. During the secondary survey, the patient complains of shortness of breath. His blood pressure is 54/14 mmHg, pulse is 200/min, respirations are 24/min, and oxygen saturation is 90% on room air. Physical exam is notable for bilateral wheezing on lung exam. The patient goes into cardiac arrest and after 30 minutes, attempts at resuscitation are terminated. Which of the following is associated with this patient's decompensation during resuscitation?

• A. COPD
• B. Congenital long QT syndrome
• C. Heart failure
• D. IgA deficiency
• E. Persistent intraabdominal bleeding (Correct Answer)

Heart failure Explanation: ***Persistent intraabdominal bleeding*** - The patient's initial presentation with **uncontrolled hemorrhage due to multiple stab wounds** is the most likely cause of his subsequent decompensation and cardiac arrest. Despite transfusion, persistent bleeding would lead to ongoing **hypovolemic shock**, explaining the worsening hypotension and tachycardia. - The patient's complaint of shortness of breath and wheezing could be a **reaction to hypovolemic shock** or a **transient pulmonary response** related to the ongoing volume loss and metabolic state, rather than a primary respiratory obstructive process. *COPD* - While the patient has a smoking history, his age (18 years old) makes significant **COPD** unlikely to be established enough to cause such a rapid and severe decompensation. - The **wheezing** could be a non-specific response to shock or hypoperfusion, not necessarily indicative of COPD exacerbation in this acute setting. *Congenital long QT syndrome* - This condition is a **cardiac electrical disorder** predisposing to arrhythmias, but it is not directly linked to the traumatic injury or the progressive hypovolemic shock in this clinical scenario. - There is no specific information in the vignette to suggest an **arrhythmia originating from a prolonged QT interval** as the primary cause of his cardiac arrest. *Heart failure* - Although the patient has a history of heart failure, his primary and overwhelming problem is **acute hemorrhagic shock** from the stab wounds. The dramatic drop in blood pressure and rise in heart rate point to volume loss, not primarily cardiogenic shock exacerbation. - While heart failure can complicate resuscitation, it is not the **direct cause of decompensation** in the face of active, life-threatening hemorrhage. *IgA deficiency* - **IgA deficiency** is an immunodeficiency associated with recurrent infections, but it has no direct pathophysiological link to acute traumatic hemorrhage or the rapid cardiovascular collapse experienced by this patient. - It would not explain the sudden severe signs of **hypovolemic shock** or cardiac arrest in this context.

Heart failure US Medical PG Question 2: A 15-year-old female presents to her family physician for an annual school physical exam and check-up. She is accompanied by her mother to the visit and is present in the exam room. The patient has no complaints, and she does not have any past medical problems. She takes no medications. The patient reports that she remains active, exercising 5 times a week, and eats a healthy and varied diet. Which of the following would be the best way for the physician to obtain a more in-depth social history, including sexual history and use of alcohol, tobacco, or recreational drugs?

• A. Disallow the mother to be present in the examination room throughout the entirety of the visit
• B. Give the patient a social history questionnaire to fill out in the exam room
• C. Ask the mother to step outside into the hall for a portion of the visit (Correct Answer)
• D. Ask the patient the questions directly, with her mother still in the exam room
• E. Speak softly to the patient so that the mother does not hear and the patient is not embarrassed

Heart failure Explanation: ***Ask the mother to step outside into the hall for a portion of the visit*** - This approach allows the physician to speak with the adolescent **privately and confidentially**, which is crucial for obtaining sensitive information such as sexual history, drug use, and mental health concerns. - Adolescents are more likely to disclose personal information when their parents are not present, fostering trust and ensuring **comprehensive history-taking** vital for their well-being. *Disallow the mother to be present in the examination room throughout the entirety of the visit* - This is an **overly restrictive** approach that might create tension or distrust between the physician, patient, and parent, especially at the start of the visit. - While privacy is essential for sensitive topics, parental presence can be valuable for discussing general health, family history, and **treatment plans**, especially for younger adolescents. *Give the patient a social history questionnaire to fill out in the exam room* - While questionnaires can be useful for gathering basic information, they often **lack the nuance** of a direct conversation and may not prompt the patient to elaborate on sensitive issues. - Furthermore, having the mother present while the patient fills out a questionnaire on sensitive topics still **compromises confidentiality** and may lead to incomplete or dishonest answers. *Ask the patient the questions directly, with her mother still in the exam room* - Asking sensitive questions with a parent present is **unlikely to yield truthful and complete answers**, as adolescents may feel embarrassed, judged, or fear parental disapproval. - This approach compromises the **confidentiality** that is fundamental to building trust with adolescent patients. *Speak softly to the patient so that the mother does not hear and the patient is not embarrassed* - Speaking softly is **unprofessional** and still does not guarantee privacy, as the mother might still overhear parts of the conversation. - This method also **fails to establish true confidentiality**, which is central to building rapport and encouraging open communication with adolescent patients about sensitive topics.

Heart failure US Medical PG Question 3: The serum brain natriuretic peptide and N-terminal pro-BNP are elevated. A diagnosis of heart failure with preserved ejection fraction is made. In addition to supplemental oxygen therapy, which of the following is the most appropriate initial step in management?

• A. Intravenous dobutamine
• B. Intravenous furosemide therapy (Correct Answer)
• C. Intravenous morphine therapy
• D. Thoracentesis
• E. Intermittent hemodialysis

Heart failure Explanation: ***Intravenous furosemide therapy*** - Heart failure with **preserved ejection fraction (HFpEF)** often presents with **pulmonary congestion** due to elevated filling pressures. - **Furosemide**, a loop diuretic, effectively reduces fluid overload and associated symptoms by increasing renal excretion of sodium and water. *Intravenous dobutamine* - **Dobutamine** is an inotropic agent that increases myocardial contractility and heart rate. - It is typically used for **acute decompensated heart failure with low cardiac output** and is generally avoided in HFpEF unless there is significant hypoperfusion, as it can worsen myocardial oxygen demand and diastolic dysfunction. *Intravenous morphine therapy* - **Morphine** can be used in acute heart failure to reduce preload and anxiety, but it is not a primary treatment for the underlying fluid overload. - It can cause respiratory depression and hypotension, and its use is typically reserved for patients with severe pain or dyspnea not adequately managed by other therapies. *Thoracentesis* - **Thoracentesis** is indicated for symptomatic **pleural effusions** causing respiratory distress. - While pleural effusions can occur in heart failure, initial management of generalized fluid overload typically involves diuretics, making thoracentesis a secondary intervention if diuretic therapy is insufficient. *Intermittent hemodialysis* - **Intermittent hemodialysis** is an invasive procedure primarily used for severe renal failure or refractory fluid overload that has not responded to maximal diuretic therapy. - It is not the initial step in managing heart failure with preserved ejection fraction and would only be considered in highly selected cases with **acute kidney injury** or diuretic resistance.

Heart failure US Medical PG Question 4: A 60-year-old male engineer who complains of shortness of breath when walking a few blocks undergoes a cardiac stress test because of concern for coronary artery disease. During the test he asks his cardiologist about what variables are usually used to quantify the functioning of the heart. He learns that one of these variables is stroke volume. Which of the following scenarios would be most likely to lead to a decrease in stroke volume?

• A. Anxiety
• B. Heart failure (Correct Answer)
• C. Exercise
• D. Pregnancy
• E. Digitalis

Heart failure Explanation: ***Heart failure*** - In **heart failure**, the heart's pumping ability is impaired, leading to a reduced **ejection fraction** and thus a decreased **stroke volume**. - The weakened myocardium cannot effectively contract to expel the normal volume of blood, resulting in lower blood output per beat. *Anxiety* - **Anxiety** typically causes an increase in **sympathetic nervous system** activity, leading to increased heart rate and myocardial contractility. - This often results in a temporary **increase in stroke volume** due to enhanced cardiac performance, not a decrease. *Exercise* - During **exercise**, there is a significant **increase in venous return** and sympathetic stimulation, leading to increased **end-diastolic volume** and contractility. - This physiological response causes a substantial **increase in stroke volume** to meet the body's higher oxygen demands. *Pregnancy* - **Pregnancy** leads to significant **physiological adaptations** to accommodate the growing fetus, including a substantial increase in **blood volume**. - This increased blood volume and cardiac output result in an **increase in stroke volume** to maintain adequate perfusion for both mother and fetus. *Digitalis* - **Digitalis** is a cardiac glycoside that **increases intracellular calcium** in myocardial cells, enhancing the **force of contraction**. - This positive inotropic effect leads to an **increased stroke volume** by improving the heart's pumping efficiency.

Heart failure US Medical PG Question 5: A 70-year-old Caucasian male visits your office regularly for treatment of New York Heart association class IV congestive heart failure. Which of the following medications would you add to this man's drug regimen in order to improve his overall survival?

• A. Spironolactone (Correct Answer)
• B. Furosemide
• C. Amiloride
• D. Acetazolamide
• E. Hydrochlorothiazide

Heart failure Explanation: ***Spironolactone*** - **Spironolactone** is an **aldosterone antagonist** that has been shown to reduce mortality and morbidity in patients with **NYHA Class III and IV heart failure**. - It works by blocking the harmful effects of **aldosterone** on the heart, such as **fibrosis** and remodeling, improving cardiac function and survival. *Furosemide* - **Furosemide** is a **loop diuretic** primarily used to relieve **symptoms of congestion** (edema, dyspnea) in heart failure by promoting fluid excretion. - While it improves symptoms, **furosemide** alone does not significantly improve long-term survival in patients with heart failure. *Amiloride* - **Amiloride** is a **potassium-sparing diuretic** that works by blocking sodium channels in the collecting duct, leading to modest diuresis. - It is often used to prevent **hypokalemia** caused by other diuretics but does not have the same proven mortality benefit in heart failure as spironolactone. *Acetazolamide* - **Acetazolamide** is a **carbonic anhydrase inhibitor** primarily used for glaucoma, metabolic alkalosis, and altitude sickness. - It has a weaker diuretic effect and is not a commonly used or recommended medication for improving long-term survival in patients with heart failure. *Hydrochlorothiazide* - **Hydrochlorothiazide** is a **thiazide diuretic** primarily used for hypertension and mild to moderate edema. - While it can help manage fluid retention, it does not offer the same mortality benefit in advanced heart failure as aldosterone antagonists like spironolactone.

Heart failure US Medical PG Question 6: A 72-year-old man presents to the outpatient clinic today. He has New York Heart Association class III heart failure. His current medications include captopril 20 mg, furosemide 40 mg, potassium chloride 10 mg twice daily, rosuvastatin 20 mg, and aspirin 81 mg. He reports that he generally feels well and has not had any recent worsening of his symptoms. His blood pressure is 132/85 mm Hg and heart rate is 84/min. Physical examination is unremarkable except for trace pitting edema of the bilateral lower extremities. What other medication should be added to his heart failure regimen?

• A. Losartan
• B. Metoprolol tartrate
• C. Isosorbide dinitrate/hydralazine
• D. Metoprolol succinate (Correct Answer)
• E. Digoxin

Heart failure Explanation: ***Metoprolol succinate*** - Current guidelines recommend adding a **beta-blocker** (specifically metoprolol succinate, carvedilol, or bisoprolol) as part of guideline-directed medical therapy (GDMT) for **NYHA class II-IV heart failure with reduced ejection fraction (HFrEF)**. - This patient is already on an **ACE inhibitor and diuretic** but is missing a **beta-blocker**, which is a cornerstone of HFrEF therapy. - Beta-blockers **reduce mortality and morbidity** in HFrEF by counteracting chronic sympathetic activation, improving cardiac remodeling, and reducing heart rate. - Metoprolol succinate is the **long-acting formulation** preferred for chronic heart failure management. ***Incorrect Option: Losartan*** - The patient is already on an **ACE inhibitor (captopril)**, which acts on the renin-angiotensin-aldosterone system. - Adding an **ARB (angiotensin receptor blocker)** like losartan to an ACE inhibitor is generally not recommended due to increased risk of hyperkalemia, hypotension, and renal dysfunction without significant additional benefit. - ARBs are typically used as an alternative when patients cannot tolerate ACE inhibitors (e.g., due to cough or angioedema). ***Incorrect Option: Metoprolol tartrate*** - While metoprolol tartrate is a beta-blocker, it is a **short-acting formulation** typically used for acute conditions like hypertension or angina. - For **chronic heart failure management**, **long-acting beta-blockers** such as metoprolol succinate are preferred due to sustained therapeutic levels, better adherence, and proven mortality benefit in clinical trials. ***Incorrect Option: Isosorbide dinitrate/hydralazine*** - This combination is primarily indicated for **African American patients with NYHA class III-IV HFrEF** who remain symptomatic despite optimal therapy, or as an alternative in patients who cannot tolerate ACE inhibitors/ARBs. - While the patient has class III heart failure, he is **not yet on a beta-blocker**, which is a more fundamental component of GDMT and should be added first. - This combination is typically added as a fourth-line agent. ***Incorrect Option: Digoxin*** - Digoxin is considered for patients with **HFrEF who remain symptomatic** despite optimized therapy with ACE inhibitors/ARBs, beta-blockers, and mineralocorticoid receptor antagonists (MRAs). - It primarily helps **improve symptoms and reduce hospitalizations** but does not reduce mortality. - Since this patient is not yet on a beta-blocker, adding the beta-blocker takes priority.

Heart failure US Medical PG Question 7: A 78-year-old man presents to the clinic complaining of shortness of breath at rest and with exertion. He also complains of difficulty breathing while lying down. He also is concerned because he startles from sleep and feels like he is choking. These symptoms have been bothering him for the last several weeks and they are getting worse. He has been afebrile with no known sick contacts. 6 months ago, he had an acute myocardial infarction from which he recovered and until recently had felt well. He has a history of hyperlipidemia for which he takes atorvastatin. His temperature is 37.0°C (98.6°F), the pulse is 85/min, the respiratory rate is 14/min, and the blood pressure is 110/75 mm Hg. On physical examination, his heart has a regular rate and rhythm. He has bilateral crackles in both lungs. An echocardiogram is performed and shows a left ventricular ejection fraction of 33%. What medication should be started?

• A. Captopril (Correct Answer)
• B. Levofloxacin
• C. Verapamil
• D. Niacin
• E. Nitroglycerin

Heart failure Explanation: ***Captopril*** - The patient presents with classic symptoms of **heart failure** (shortness of breath at rest and with exertion, orthopnea, paroxysmal nocturnal dyspnea), a history of **myocardial infarction**, and a **reduced left ventricular ejection fraction (LVEF) of 33%**. - **ACE inhibitors** like captopril are first-line agents for heart failure with reduced ejection fraction (HFrEF) as they **improve survival**, reduce hospitalizations, and alleviate symptoms by decreasing **afterload** and **preload**, and preventing cardiac remodeling. *Levofloxacin* - This is an **antibiotic** used to treat bacterial infections. - While crackles can be present in pneumonia, the patient is **afebrile**, has no sick contacts, and the clinical picture, including orthopnea and paroxysmal nocturnal dyspnea, points strongly to **heart failure**, not infection. *Verapamil* - **Verapamil** is a **non-dihydropyridine calcium channel blocker** predominantly used for rate control in arrhythmias or to treat hypertension and angina. - It has a negative **inotropic effect** and can **worsen heart failure** in patients with reduced ejection fraction, making it contraindicated in this case. *Niacin* - **Niacin** is used to lower **LDL cholesterol** and raise **HDL cholesterol**, often for dyslipidemia. - While the patient has a history of hyperlipidemia, his acute symptoms and low ejection fraction indicate a need for **heart failure treatment**, not additional lipid management. *Nitroglycerin* - **Nitroglycerin** is a **vasodilator** primarily used for **angina** or in acute heart failure to reduce preload and afterload. - While it might provide temporary symptomatic relief in acute decompensated heart failure, it's not a long-term foundational therapy like ACE inhibitors for **chronic HFrEF** to improve survival and prevent progression.

Heart failure US Medical PG Question 8: A 66-year-old man is brought to the emergency department because of shortness of breath and confusion. His pulse is 98/min, and blood pressure is 109/73 mm Hg. He is oriented to person but not time or place. A graph of his breathing pattern and oxygen saturation is shown. Which of the following additional findings is most likely present in this patient?

• A. Rib fracture
• B. Fruity breath odor
• C. Ventricular gallop (Correct Answer)
• D. Miotic pupils
• E. Barrel chest

Heart failure Explanation: ***Ventricular gallop*** - The patient's presentation with **shortness of breath**, **confusion**, and **oxygen desaturation** coupled with the breathing pattern shown (likely Cheyne-Stokes respiration from the image) strongly suggests **heart failure**. A **ventricular gallop (S3 heart sound)** is a classic finding in heart failure, indicating rapid ventricular filling into a stiff or dilated ventricle. - The **confusional state** and **tachypnea (implied by oxygen desaturation)** are consistent with **hypoxia** and **reduced cardiac output** often seen in decompensated heart failure, where an S3 gallop is frequently heard. *Rib fracture* - While a rib fracture can cause shortness of breath due to pain and reduced chest expansion, it would not typically lead to **confusion** or a specific cyclical breathing pattern like Cheyne-Stokes, nor would it directly cause a ventricular gallop. - The patient's vital signs and mental status point towards a more systemic issue rather than isolated chest trauma. *Fruity breath odor* - A **fruity breath odor** is a hallmark of **diabetic ketoacidosis (DKA)**, caused by the exhalation of acetone. This condition would also present with confusion and tachypnea, but would typically involve hyperglycemia and metabolic acidosis. - There is no information to suggest diabetes, and the presentation of a specific breathing pattern in correlation with cardiac findings makes heart failure more likely. *Miotic pupils* - **Miotic pupils (pinpoint pupils)** are strongly associated with **opioid overdose** or organophosphate poisoning. These conditions would cause respiratory depression, not necessarily the specific breathing pattern, and would not explain the other findings in this specific context. - The patient's pulse and blood pressure are also not typical of severe opioid overdose, which often involves bradycardia and hypotension. *Barrel chest* - A **barrel chest** is a physical finding typically associated with **chronic obstructive pulmonary disease (COPD)** due to chronic air trapping. While COPD can cause shortness of breath and confusion (in acute exacerbations), it does not directly lead to a ventricular gallop. - Although the patient's age makes COPD possible, the acute presentation with a specific breathing pattern and the likelihood of heart failure make a barrel chest a less specific or primary finding in this context.

Heart failure US Medical PG Question 9: An 80-year-old African American male presents complaining of worsening shortness of breath that occurs during his weekly round of golf. He also notes he has been waking up at night "choking and gasping for air", though he has been able to gain some relief by propping his head on a stack of pillows before he goes to bed. Upon auscultation, a low frequency, early diastolic gallop is heard over the apex while the patient rests in the left lateral decubitus position. This finding is most consistent with which of the following?

• A. Left ventricular concentric hypertrophy
• B. Right atrial hypertrophy
• C. Mitral stenosis
• D. Left atrial hypertrophy
• E. Left ventricular eccentric hypertrophy (Correct Answer)

Heart failure Explanation: ***Left ventricular eccentric hypertrophy*** - The symptoms of **dyspnea on exertion** and **paroxysmal nocturnal dyspnea** (relieved by propping up pillows) are classic for **left-sided heart failure**. - An **early diastolic gallop** (S3 heart sound) heard best at the apex in the left lateral decubitus position is indicative of **volume overload** and a failing, dilated left ventricle, consistent with eccentric hypertrophy. *Left ventricular concentric hypertrophy* - Concentric hypertrophy is typically associated with **pressure overload** (e.g., hypertension, aortic stenosis) and often presents with a **late diastolic gallop (S4)** due to a stiff, non-compliant ventricle. - While it can lead to heart failure, the presence of an **S3 gallop** points more strongly to a dilated, volume-overloaded ventricle. *Right atrial hypertrophy* - Right atrial hypertrophy results from **right ventricular dysfunction** or conditions like **pulmonary hypertension** and would manifest with symptoms of right heart failure (e.g., peripheral edema, jugular venous distention), not primarily left-sided symptoms. - It is not directly associated with a left ventricular early diastolic gallop. *Mitral stenosis* - Mitral stenosis typically causes a **mid-diastolic murmur** with an opening snap, and its symptoms are usually related to elevated left atrial pressure leading to pulmonary congestion and dyspnea. - An **S3 gallop** is not characteristic of mitral stenosis; it's more specific for left ventricular systolic dysfunction. *Left atrial hypertrophy* - Left atrial hypertrophy (enlargement) commonly results from conditions like **mitral valve disease** or **left ventricular diastolic dysfunction** but does not directly cause an S3 gallop. - While it contributes to symptoms of left heart failure, it's a consequence rather than the primary cause of an S3.

Heart failure US Medical PG Question 10: A 42-year-old woman comes to the physician because of 2 episodes of loss of consciousness over the past week. She recovered immediately and was not confused following the episodes. During the past 5 months, she has also had increased shortness of breath and palpitations. She has been unable to carry out her daily activities. She also reports some chest tightness that resolves with rest. She has no history of serious illness and takes no medications. She immigrated with her family from India 10 years ago. Her temperature is 37.3°C (99.1°F), pulse is 115/min and irregular, and blood pressure is 108/70 mm Hg. Examination shows jugular venous distention and pitting edema below the knees. Bilateral crackles are heard at the lung bases. Cardiac examination shows an accentuated and split S2. There is an opening snap followed by a low-pitched diastolic murmur in the fifth left intercostal space at the midclavicular line. An ECG shows atrial fibrillation and right axis deviation. Which of the following is the most likely underlying mechanism of these findings?

• A. Increased left ventricular end diastolic pressure
• B. Increased left to right shunting
• C. Increased systemic arterial resistance
• D. Increased left atrial pressure (Correct Answer)
• E. Decreased left ventricular contractility

Heart failure Explanation: ***Increased left atrial pressure*** - The patient's symptoms (dyspnea, palpitations, chest tightness, volume overload signs like JVD, edema, crackles) and cardiac findings (**accentuated S2, opening snap, diastolic murmur**) are highly suggestive of **mitral stenosis**. - **Mitral stenosis** causes obstruction of blood flow from the left atrium to the left ventricle, leading to a significant increase in **left atrial pressure** to maintain cardiac output, which can then cause atrial fibrillation and pulmonary hypertension. *Increased left ventricular end diastolic pressure* - This is typically seen in conditions like **aortic stenosis**, **aortic regurgitation**, or **decompensated heart failure** where the left ventricle is distended or failing. - The patient's presentation with an **opening snap** and **diastolic murmur** points away from primary left ventricular pathology causing elevated LVEDP, and more towards a valvular issue upstream. *Increased left to right shunting* - This typically occurs in **septal defects** (e.g., VSD, ASD, PDA) and would lead to symptoms of pulmonary hypertension and right heart strain, but the specific murmur and opening snap are not characteristic of a shunt. - While it can cause right ventricular hypertrophy and pulmonary hypertension, the classic auscultatory findings are distinct from those described here. *Increased systemic arterial resistance* - This is characteristic of **hypertension** or conditions causing systemic vasoconstriction, which primarily affect afterload on the left ventricle. - While it can lead to left ventricular hypertrophy over time, it does not explain the specific findings of an **opening snap** and **diastolic murmur**, or the symptoms of pulmonary congestion in this context. *Decreased left ventricular contractility* - This would lead to **systolic heart failure** with reduced ejection fraction, causing symptoms like fatigue and dyspnea, and often a **S3 gallop** with a systolic murmur if mitral regurgitation develops. - However, it does not explain the specific auscultatory findings of an **opening snap** and **diastolic murmur** that are pathognomonic for mitral stenosis.

Heart failure Flashcard 1 of 10

Question: What is the treatment plan for acute decompensated heart failure? L_____ - most important intervention M_____ - limited evidence for use N_____ O_____ P_____

Answer: asix (furosemide)

Extra Information:  https://onlinemeded.org/spa/cardiology/heart-failure/acquire?ref=anki 

Heart failure Flashcard 2 of 10

Question: High-output heart failure = _____ LAP and _____ CO and _____ TPR

Answer: ↑

Extra Information:  https://onlinemeded.org/spa/surgery?ref=anki 

Heart failure Flashcard 3 of 10

Question: ACE inhibitors are first line agents in the treatment of heart _____

Answer: failure

Heart failure Flashcard 4 of 10

Question: Right-heart failure following implantable pacemaker / cardioverter-defibrillator placement = _____

Answer: tricuspid regurgitation

Extra Information:  https://onlinemeded.org/spa/surgery?ref=anki 

Heart failure Flashcard 5 of 10

Question: The NYHA classification of heart failure is based on _____

Answer: degree of functional limitation (i.e. activity tolerance)

Extra Information:  https://onlinemeded.org/spa/cardiology/heart-failure/acquire?ref=anki 

Heart failure Flashcard 6 of 10

Question: CHF + EF < 35% = add _____ or biventricular pacemaker

Answer: automated implantable cardioverter defribrillator (AICD)

Extra Information:  https://onlinemeded.org/spa/cardiology/heart-failure/acquire?ref=anki 

Heart failure Flashcard 7 of 10

Question: What is the most common cause of heart failure with preserved ejection fraction (HFpEF)? _____

Answer: Chronic uncontrolled hypertension

Extra Information:  https://onlinemeded.org?ref=anki 

Heart failure Flashcard 8 of 10

Question: Coronary artery disease is the most common cause of heart failure, which leads to _____ contractility, stroke volume, and therefore cardiac output

Answer: reduced

Extra Information:  https://onlinemeded.org/spa/cardiology/heart-failure/acquire?ref=anki 

Heart failure Flashcard 9 of 10

Question: Heart failure may present with dependent _____ edema due to increased hydrostatic pressure

Answer: pitting

Extra Information:   Watch Congestive Heart Failure Clinical Manifestations [https://dashboard.sketchy.com/study/medical/courses/medical-pathophysiology/units/medical-pathophysiology-cardiac/videos/medical-pathophysiology-cardiac-heart-failure-congestive-heart-failure-clinical-manifestations?utm_source=anki&utm_medium=partnership&utm_campaign=february_update&utm_content=medical]Watch associated Bootcamp video [https://app.bootcamp.com/med-school/cardiology/videos/heart-failure?index=2] https://onlinemeded.org/spa/cardiology/heart-failure/acquire?ref=anki 

Heart failure Flashcard 10 of 10

Question: How does ejection fraction change in heart failure with systolic dysfunction? _____

Answer: Reduced EF

Extra Information:  Watch Congestive Heart Failure Pathophysiology [https://dashboard.sketchy.com/study/medical/courses/medical-pathophysiology/units/medical-pathophysiology-cardiac/videos/medical-pathophysiology-cardiac-heart-failure-congestive-heart-failure-pathophysiology?utm_source=anki&utm_medium=partnership&utm_campaign=february_update&utm_content=medical]Watch associated Bootcamp video [https://app.bootcamp.com/med-school/cardiology/videos/heart-failure?index=3] https://onlinemeded.org/spa/cardiology/heart-failure/acquire?ref=anki