MTB 2

Question 1

Presentation of CHF

Answer 1

Dyspnea

Question 2

Which type of Heart failure is there preserved EF

Answer 2

Diastolic

Question 3

Systolic Dysfunction

MC Causes

Answer 3

Dilated Cardiomyopathy + Low EF
Infarction
Cardiomyopathy
Valve disease

Question 4

MCC of CHF

Answer 4

HTN resulting in cardiomyopathy or of myocardial muscle

Question 5

Presentation of Systolic Dysfnc

Answer 5

Dyspnea (SOB), DOE
Pulmonary Edema = worst form
Orthopnea
Peripheral Edema
Rales 
JVD
Paroxysmal nocturnal dyspnea (PND)
S3 gallop

Question 6

What is an S3 Gallop

Answer 6

Ken-Tucky
Low frequency
Early Diastolic 
Inflow from LA strikes blood that is already in LV - Reverberation of blood b/t LV walls
Sign of LV Failure

Question 7

Is S3 ever normal?

Answer 7

Can be normal in athletes and young adult

Question 8

When do we hear S4

Answer 8

Late Diastole

Question 9

Dyspnea + dullness to percussion at bases

Answer 9

Pleural Effusion

Question 10

Dyspnea + recent anesthetic use + brown blood , not improved with oxygen, clear lungs

Answer 10

Methemoglobinemia

Question 11

Most important test for CHF

Answer 11

Echo

Only way to differentiate b/c systolic and diastolic

Question 12

Best initial test for EF

Answer 12

TTE

Question 13

Most accurate test for EF

Answer 13

MUGA

Nuclear Ventriculography

Question 14

Most accurate test for heart valve function

Answer 14

TEE

Question 15

Reduce mortality in Systolic Dysfunction

Answer 15

ACE/ARBs
Beta Blockers
Spironolactone
Hydralazine/nitrates
Implantable defibrillator

Question 16

First line TX for Systolic Dysfunction

Answer 16

Diuretic + Vasodilator

Question 17

Beta blockers used in Systolic Dysfunction

Answer 17

Metoprolol - B1 only
Bisoprolol - B1 only
Carvedilol - non-specific, a-1 antag

Question 18

Which drugs do we NOT use in Diastolic dysfunction

Answer 18

Digoxin
Spironolactone

Uncertain benefit
ACE/ARBs
Hydralazine

Question 19

Vasodilators used in Systolic Dysfunction

Answer 19

ACE, ARBS
Hydralazine
Nitrates

Question 20

Why are beta blockers used in CHF

Answer 20

Antiischemic
Decrease HR = decreased O2 consumption
Antiarrhythmic

Question 21

MCC death from CHF

Answer 21

Arrhythmias

Sudden death

Question 22

Presentation of Beta blocker toxicity

Answer 22

Bradycardia
AV block
HypoTN
Diffuse wheezing
Cardiogenic shock = cold, clammy
Delirium
Seizures
Hypoglycemia

Question 23

TX for Beta blocker toxicity

Answer 23

Glucagon - increases cAMP to increase contractility
Calcium Gluconate 
Epinephrine 
Insulin
Sodium Bicarbonate

Question 24

Spironolactone MOA
Use?
AE?

Answer 24

Inhibits Aldosterone
Advanced CHF - Class III, IV
gynecomastia, Hyperkalemia

Question 25

CHF pt develops gynecomastia

Answer 25

Switch spironolactone to Eplerenone

Question 26

Presentation of Digoxin Toxicity

Answer 26

GI: N/V Arrhythmia - Atrial Tach w AV block, paroxysmal atrial tachycardia Blurred vision, yellow halos

Question 27

TX of Digoxin toxicity

Answer 27

1. Stop drug 2. Administer K+ if needed 3. Lidocaine + Phenytoin 4. Digibind = digoxin immune fab only for acute OD

Question 28

Does Digoxin lower mortality in CHF

Answer 28

No. | Controls Sx's

Question 29

When do we use implantable defibrillator

Answer 29

Ischemic Cardiomyopathy + EF < 35%

Question 30

When do we use biventricular pacemaker

Answer 30

Dilated Cardiomyopathy + EF < 35% + QRS > 120 msec

Question 31

What is Diastolic Dysfunction

Answer 31

CHF w Preserved EF

Question 32

Which drugs are clearly beneficial in Diastolic Dysfunction

Answer 32

Beta blockers | Diuretics

Question 33

Which drugs are clearly NOT beneficial in Diastolic Dysfunction

Answer 33

Digoxin | Spironolactone

Question 34

Does implantable defibrillator lower mortality in diastolic dysfunction?

Answer 34

Yes

Question 35

What is Pulmonary Edema

Answer 35

Worst, most severe form of CHF | Rapid onset of fluid in lungs

Question 36

Presentation of Pulmonary Edema

Answer 36

``` Rales JVD S3 Gallop Edema Orthopnea Cyanosis Increased respiratory rate Productive cough with pink, frothy sputum Noctural Dyspnea Ascites, enlarged liver and spleen ```

Question 37

What does a normal BNP exclude

Answer 37

CHF | Pulmonary Edema

Question 38

CXR in Pulmonary Edema

Answer 38

Vascular Congestion | Cephalization of flow (filling of blood vessels twds head)

Question 39

ABG in Pulmonary Edema

Answer 39

Hypoxia Respiratory Alkalosis bc of hyperventilation Increased RR = so CO2 leaves more easily than O2 enters bloodstream

Question 40

Hypoxia v Hypoxemia

Answer 40

Hypoxia - inadequate O2 supply in body | Hypoxemia - low arterial O2 supply

Question 41

Management if A fib, A flutter, or V tach are cause of Pulmonary Edema

Answer 41

Rapid synchronized cardioversion

Question 42

What tests done in Pulmonary Edema

Answer 42

EKG | Echo

Question 43

TX for Pulmonary Edema

Answer 43

Preload reduction: MONA Positive Inotropes - Dobutamine - Amrinone and milrinone - PDE inhibitors that increase contractility and decrease afterload Positive inotrope, increases contractility Afterload Reduction - ACE/ARBs

Question 44

TX for chronic Pulmonary Edema

Answer 44

Digoxin | ACE/ARBs

Question 45

MCC regurgitant disease

Answer 45

HTN | Ischemic heart dz

Question 46

Consequences of infarction

Answer 46

Regurgitation -> Dilatation -> CHF

Question 47

Murmurs that increase in intensity/loudness w inhalation

Answer 47

Right sided - inhalation increases venous return to right Tricuspid Pulmonic

Question 48

Murmurs that increase in intensity/loudness w exhalation

Answer 48

Left sided - exhalation squeezes blood out of lungs, into left Mitral Aortic

Question 49

Best initial test pulmonary edema

Answer 49

TEE

Question 50

Most accurate test pulmonary edema

Answer 50

Catheterization