Fun stuff
Medications
Epidemiology
Diagnosis
Treatment
100
What is the definition of systolic heart failure?
ejection fraction ≤ 40%
100
which 3 beta blockers have been shown to reduce hospitalizations, sudden death, and overall mortality in patients with heart failure?
Carvedilol, bisoprolol, and long-acting metoprolol succinate.
100
what is the most common cause of heart failure in developed countries?
Repeated bouts of myocardial ischemia
100
What 2 physical examination maneuvers can help bring out an S3 more audibly?
(1) lying the patient in a left lateral decubitus position (2) ask the patient to exhale completely while in that position
100
what vaccinations should all patients with heart failure receive?
Pneumococcal and annual influenza vaccine.
200
why are rales absent in chronic heart failure despite elevated left filling pressures?
chronic lymphatic hypertrophy prevents alveolar edema despite elevated interstitial pressure
200
what is the MOA of carvedilol?
non selective beta adrenergic antagonist with alpha blocking effects
200
what is the 5 year mortality for all patients with congestive heart failure?
45%
200
what is the 6-minute walk test
used to evaluate functional capacity in patients with suspected heart failure to determine treatment Ask pt to walk 6 minutes in a straight line back & forth between 2 points separated by 60ft. allow the pt to stop, rest, or sit if they need to. The total distance walked in 6 minutes correlates well with other measures of functional capacity.
200
If an ionotropic agent is indicated for a patient in acute decompensated heart failure which one would you choose?
Dobutamine
300
What are drugs of particular concern with Digoxin?
1. Amiodarone - Reduces renal excretion and increases digoxin level 2. Potassium depleting drugs - Increase likelihood of digitalis toxicity
300
what are the signs of nitroprusside toxicity and how is it managed?
seizures, altered mental status, nausea, lactic acidosis. tx- IV sodium thiosulfate and sodium nitrite
300
is the prevalence of heart failure increasing or decreasing in the united states?
increasing
300
what tests should you order for a new patient with CHF?
cxr, ecg, cardiac enzymes, cbc, echocardiogram
300
what is the best time for a patient with heart failure to weigh themselves?
in the morning when the wake up
400
What kind of heart failure can be seen in chronic severe anemia
high output cardiac failure (large arteriovenous fistula or multiple small arteriovenous shunts as in Paget's bone disease, some forms of severe hepatic or renal disorders, and acute septic shock)
400
Which drug is used more often: lisinopril or captopril and why
lisinopril because it is dosed QD vs. TID for captopril
400
____% of people who presented to primary care with dyspnea had a diagnosis of heart failure
9%
400
30 year old male recently immigrated from Brazil complaining of exertional dyspnea over the past 7 months. No other associated symptoms. CXR shows cardiomegaly. S3 murmur is present. What's the most likely diagnosis?
Chagas disease
400
What is the recommend total amount of salt intake for a person with heart failure?
2,000mg
500
Is left ventricular relaxation an active or passive process?
Active- Ca2+ is forced back into the SR via the SERCA pump. Ca2+ reuptake into the SR allows the actin-myosin bridges to separate so relaxation can occur. Abnormal ca2+ reuptake can effect diastolic function.
500
If a person with heart failure has a headache what is the best pain medication for them to take (aspirin, tyelnol, advil/motrin, excedrin)
tylenol (acetaminophen)
500
what is the most common post operative complication of left ventricular assist devices (LVAD)?
Bleeding
500
A previously healthy young person with no significant past medical history develops symptoms of CHF. What diagnosis should be high on your ddx?
Myocarditis-coxsackie B virus
500
when is spironolactone contraindicated in a patient with heart failure?
If the patient also has renal failure
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