heart failure

Question 1

inability of the heart to meet the body’s metabolic needs. at rest or during stress, without exceeding physiologic left and right filling pressures s

Answer 1

heart failure

Question 2

most common primary diagnosis on admissions within the medicare population

Answer 2

heart failure

Question 3

total cost of heart failure in US

Answer 3

28.8 billion

Question 4

cost of HF sustainable?

Answer 4

nope

Question 5

independent risk factors of HF

Answer 5

1. HTN
2. obesity
3. diabetes

Question 6

treatments for HF

Answer 6

1. digoxin
2. diuretics
3. bed rest

Question 7

HF prognosis

Answer 7

1. progressive disability

2. uniform mortality

Question 8

determinants of systolic performance

Answer 8

ejection fraction:

1. myocardial mass and architecture
2. contractility
3. preload
4. afterload

Question 9

how to measure cardiac output

Answer 9

thermodilution

Question 10

goal of managing HF

Answer 10

achieve adequate cardiac output while minimizing wedge P

Question 11

Diastolic relaxation components (3)

Answer 11

1. Myofibrillar dissociation
2. Calcium removal from the cytoplasm against the concentration gradient
3. Requires enzymatic action and energy

Question 12

Diastolic passive compliance components (2)

Answer 12

1. A tissue property (stress-strain relationship) during passive myocardial stretch
2. A ventricular property related to both myocardial stretch response and to constraining effect of contiguous structures

Question 13

Systolic dysfunction:

1. Etiology
2. Pathology components
3. Pathophysiology

Answer 13

1. Chronic volumes overload, ischemia, infectious, substance abuse or genetic
2. Dilated LV and hypertrophied LV and/or RV
3. Decrease in contractility and decrease resting EF (LV remodeled with dilation)

Question 14

Diastolic dysfunction; HHpEF; Metabolic CV dx.:

1. Etiology
2. Pathology
3. Pathophysiology

Answer 14

1. HTN, Diabetes, Obesity and advanced age
2. Hypertrophy, fibrosis w/out dilatation
3. NI resting EF (non-dilated LV) with decrease relaxation and decrease in compliance

Question 15

Increased load structure HF:

1. Etiology
2. Pathology
3. Pathophysiology

Answer 15

1. Valvular, congenital, obstructive, systemic shunt
2. Hypertrophy and/or dilatation
3. Pressure and/or volume overload

Question 16

Increased load and demand HF:

1. Etiology
2. Pathology
3. Pathophysiology

Answer 16

1. Anemia and thyrotoxicosis
2. Dilated and hypertrophied LV and RV
3. Increased C.O. And increased O2 consumption or decreased O2 extraction

Question 17

Restrictive/ constrictive HF:

1. Etiology
2. Pathology
3. Pathophysiology

Answer 17

1. Infiltration, inflammatory and neoplasticism
2. Infiltrated / thickened mayo/ pericardium
3. Restricted LV and RV filling

Question 18

Left Heart failure HF:

1. Etiology
2. Manifestations

Answer 18

1. MI, cardiomyopathy, valvular congenital, HTN

2. Pulmonary congestion and low cardiac output

Question 19

Right Heart failure:

1. Etiology
2. Manifestations

Answer 19

1. Left heart failure, MI, cardiomyopathy, valvular, congenital, cardiomyopathy, lung disease and pulmonary emboli
2. Peripheral edema, ascites, low cardiac output

Question 20

Heart failure has a maladaptive adaptation

Answer 20

the heart will undergo hypertrophy to normalize wall stress and systolic function but it will lead to altered contractile proteins and calcium handling, apoptosis, fibrosis and failure

Question 21

function of natriuretic peptides

Answer 21

vasodilate and promote sodium excretion

Question 22

high pulmonary venous pressure

Answer 22

left heart failure

Question 23

high systemic venous pressure

Answer 23

right heart failure

Question 24

NY heart association class (4)

Answer 24

1. no symptoms
2. symptoms on mod-severe exertion
3. symptoms on mild exertion
4. symptoms at rest

Question 25

ivabradine

Answer 25

heart rate lowering agent acting by inhibiting the If current in the sino-atrial node

Question 26

Shift trial hypothesis

Answer 26

addition of ivabradine to recommended therapy would be beneficial in heart failure patients with elevated heart rate

Question 27

neprilysin

Answer 27

inhibition leads to a potentiation of vasoactive peptides that counter maladaptive mechanisms in HF

Question 28

produces a positive inotropic effect through inhibition of the Na-K exchanger that results in higher intracellular sodium levels causing increased calcium transport via sodium-calcium exchange channel

Answer 28

digoxin

Question 29

the loss of what can worsen HF?

Answer 29

synchronous LV contraction

Question 30

most commonly used drug for suppression of ventricular arrhythmias in HF is

Answer 30

amiodarone

Question 31

indications for implantable cardioverter defibrillators

Answer 31

syncope or resuscitated cardiac arrest thought ti be due to a ventricular arrhythmia

Question 32

clinical assessment of hemodynamic status (2)

Answer 32

1. thermodilution | 2. swanz catheter

Question 33

thermodiultion can measure _____ but there are some pitfalls in inaccuracy such as with (2)

Answer 33

CO 1. tricuspid regurg 2. fluctuation in body temp

Question 34

Total uptake and release of a substance by an organ equals the blood flow to the organ and the arterio-venous concentration difference for that substance

Answer 34

Fick's method

Question 35

Non-invasive general assessment of atrial, ventricular and valve structure and function

Answer 35

TTE

Question 36

Invasive and requires conscious sedation Higher resolution imaging gives better assessment of valvular structure (e.g. infectious vegitations on valve from endocarditis)

Answer 36

TEE

Question 37

Color-flow doppler measures blood velocity (direction and speed) by either TTE or TEE Does not measure pressure directly, but can make inferences about pressure by converting velocity to pressure:

Answer 37

echo

Question 38

Reflection of intravascular volume status Estimated by pressure in the right atrium (“central venous pressure or CVP”) and/or left atrium (“pulmonary capillary wedge pressure”)

Answer 38

Preload: volume of blood in LV at end-diastole

Question 39

Reflection of the heart’s intrinsic ability to contract and generate force during systolic Estimated generally by the Left Ventricular Ejection Fraction

Answer 39

Contractility: ability of myocardium to contract

Question 40

Left ventricular wall stress | Estimated by systemic vascular resistance (SVR) or mean arterial pressure

Answer 40

Afterload: resistance to ventricular contraction

Question 41

disease modifying therapies for HF

Answer 41

1. catecholamine pathway 2. RAAS pathway 3. revascularization

Question 42

palliative therapies for HF

Answer 42

1. diuretics | 2. implantable defibrillator

Question 43

is a life-threatening medical condition of low tissue perfusion resulting in oxygen and nutrient deficit (ischemia/infarction) the impairs tissue function

Answer 43

Circulatory shock

Question 44

types of shock (4)

Answer 44

1. hypovolemic 2. cardiogenic 3. septic 4. obstructive

Question 45

causes: 1. Hypovolemic 2. Cardiogenic 3. Septic 4. Obstructive

Answer 45

1. Hypovolemic GI bleeding, excessive diarrhea and dehydration Cardiogenic s/p large myocardial infarction, acute valvular disorder Septic Significant systemic infection Obstructive Pulmonary embolus

Question 46

primary problem: hypovolemic

Answer 46

low preload

Question 47

primary problem: cardiogenic

Answer 47

loss of contractility

Question 48

primary problem: septic

Answer 48

non-specific vasodilation and dehydration

Question 49

primary problem: obstructive

Answer 49

physical blockage preventing blood flow

Question 50

inotropic drugs used (3)

Answer 50

1. Beta-adrenergic agonists 2. phosphodiesterase inhibitors 3. digitalis glycosides

Question 51

2 key components of diastolic function:

Answer 51

1. relaxation | 2. compliance

Question 52

is the process of myofibrillar dissociation, an active process requiring enzymatic action and energy to remove calcium from the cytoplasm against the concentration gradient.

Answer 52

relaxation

Question 53

is the passive property of the myocardium or of a cardiac chamber, describing (for an intact cardiac chamber) the change in volume for a given change in filling pressure, after relaxation is complete.

Answer 53

compliance

Question 54

. A low ejection fraction is generally accompanied by

Answer 54

ventricular dilatation.

Question 55

Systolic dysfunction is most often a consequence of

Answer 55

myocardial infarction (“ischemic cardiomyopathy”) or primary myocardial disease (“dilated cardiomyopathy”)

Question 56

Isolated, or primary, diastolic dysfunction occurs most commonly in the _____, as a consequence of long-standing hypertension and resulting left ventricular hypertrophy.

Answer 56

elderly

Question 57

Diastolic dysfunction may also occur as a consequence of___________, a family of genetic disorders linked to mutations of a variety of contractile proteins.

Answer 57

familial hypertrophic cardiomyopathy

Question 58

cor pulmonale a sign of

Answer 58

right heart failure

Question 59

long standing pressure-overload, as exemplified by hypertensive cardiomyopathy

Answer 59

diastolyc dysfunction

Question 60

ventricular dilatation, reduced ejection fraction, commonly referred to as

Answer 60

“systolic dysfunction”.

Question 61

hypertrophied myocyte manifests altered expression of

Answer 61

contractile proteins and of enzymes that regulate calcium movement,

Question 62

what does the adrenergic nervous system, RAAS pathway, vasopressin and endothelin do in HF?

Answer 62

these systems and substances tend to vasoconstrict; augment contractility; promote hypertrophy and interstitial fibrosis; and induce sodium and water retention.

Question 63

levels are elevated in heart failure.

Answer 63

B-type natriuretic peptide (BNP)

Question 64

effective means of preventing or reversing progressive left ventricular dilatation (ventricular remodeling) in heart failure.

Answer 64

carvedilol

Question 65

A typical regimen for such HF patients includes an

Answer 65

ACE inhibitor, beta blocker, digoxin, and diuretic.

Question 66

These agents are useful in the management of acute exacerbations of heart failure

Answer 66

vasodilators

Question 67

reduce pulmonary capillary (artery) wedge (PCW) pressure in patients with severe heart failure

Answer 67

dobutamine and milrinone