Chapter·Internal MedicineHeart failure

Heart failure pathophysiologyDownloads

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1

A 40-year-old female volunteers for an invasive study to measure her cardiac function. She has no previous cardiovascular history and takes no medications. With the test subject at rest, the following data is collected using blood tests, intravascular probes, and a closed rebreathing circuit: Blood hemoglobin concentration 14 g/dL Arterial oxygen content 0.22 mL O2/mL Arterial oxygen saturation 98% Venous oxygen content 0.17 mL O2/mL Venous oxygen saturation 78% Oxygen consumption 250 mL/min The patient's pulse is 75/min, respiratory rate is 14/ min, and blood pressure is 125/70 mm Hg. What is the cardiac output of this volunteer?

ABody surface area is required to calculate cardiac output.

BStroke volume is required to calculate cardiac output.

C250 mL/min

D5.0 L/min

E50 L/min

2

An investigator is studying patients with acute decompensated congestive heart failure. He takes measurements of a hormone released from atrial myocytes, as well as serial measurements of left atrial and left ventricular pressures. The investigator observes a positive correlation between left atrial pressures and the serum level of this hormone. Which of the following is most likely the mechanism of action of this hormone?

AIncreases potassium excretion at the collecting ducts

BConstricts afferent renal arteriole

CDecreases sodium reabsorption at the collecting tubules

DDecreases reabsorption of bicarbonate in the proximal convoluted tubules

EIncreases free water reabsorption from the distal tubules

3

A 59-year-old man with a history of congestive heart failure presents to his cardiologist for a follow-up visit. His past medical history is notable for diabetes mellitus, hypertension, and obesity. He takes metformin, glyburide, aspirin, lisinopril, and metoprolol. He has a 40 pack-year smoking history and drinks alcohol socially. His temperature is 99.1°F (37.2°C), blood pressure is 150/65 mmHg, pulse is 75/min, and respirations are 20/min. Physical examination reveals bilateral rales at the lung bases and 1+ edema in the bilateral legs. The physician decides to start the patient on an additional diuretic but warns the patient about an increased risk of breast enlargement. Which of the following is the most immediate physiologic effect of the medication in question?

ADecreased sodium reabsorption in the distal convoluted tubule

BDecreased bicarbonate reabsorption in the proximal convoluted tubule

CDecreased sodium reabsorption in the thick ascending limb

DDecreased renin enzyme activity

EDecreased sodium reabsorption in the collecting duct

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