Pressure, Flow & Filtration
This relationship explains how increased ventricular filling leads to increased stroke volume (to a point).
What is the Frank-Starling Mechanism?
This hormone is released by the kidney in response to low perfusion.
What is renin?
These lung exam findings are caused by fluid in the alveoli.
What are crackles (rales)?
This type of cardiomyopathy is characterized by dilated ventricles and reduced ejection fraction.
What is dilated cardiomyopathy?
This drug combination increases natriuretic peptides by inhibiting neprilysin.
What is sacubitril/valsartan (ARNI)?
This renal parameter decreases when cardiac output falls, triggering compensatory mechanisms.
What is GFR (glomerular filtration rate)?
This syndrome describes worsening kidney function due to heart failure.
What is cardiorenal syndrome?
This heart sound is associated with systolic heart failure and volume overload.
What is an S3 gallop?
This cardiomyopathy features asymmetric septal hypertrophy and risk of sudden death in young athletes.
What is hypertrophic cardiomyopathy?
This loop diuretic provides rapid symptom relief in volume overload.
What is furosemide?
This equation describes cardiac output as a product of heart rate and stroke volume.
What is CO = HR × SV?
This paradoxical mechanism in HF involves kidneys sensing low perfusion despite fluid overload, worsening the condition.
What is maladaptive RAAS activation?
This mechanism explains pulmonary edema in left-sided heart failure.
What is increased pulmonary capillary hydrostatic pressure?
This cardiomyopathy is defined by stiff ventricles and impaired filling with preserved EF.
What is restrictive cardiomyopathy?
This is the most appropriate next step when an uninsured HF patient cannot afford medications.
What is involving a social worker for medication assistance and insurance support?
A 35-year-old man with newly diagnosed systolic heart failure presents with fatigue and decreased urine output. His blood pressure is 100/70 mmHg. Labs show elevated creatinine. You suspect decreased renal perfusion.
Which of the following physiologic changes is most directly responsible for the decrease in glomerular filtration rate (GFR) in this patient?
What is decreased renal blood flow?
A 35-year-old man with systolic heart failure presents with worsening fatigue and lower extremity edema. Labs show mild hyponatremia. His blood pressure is 95/65 mmHg. Due to decreased cardiac output, his kidneys activate the RAAS system.
Which of the following effects is most directly mediated by angiotensin II in this patient?
A. Increased sodium excretion in the distal nephron
B. Vasodilation of systemic arterioles
C. Constriction of efferent arterioles to maintain GFR
D. Decreased aldosterone secretion
What is C. Constriction of efferent arterioles to maintain GFR?
A 58-year-old man presents with progressive shortness of breath. He reports needing 3 pillows to sleep and waking up at night gasping for air. On exam, he has bilateral crackles and an S3 gallop. Chest X-ray shows pulmonary edema.
Which of the following best explains the mechanism of his respiratory symptoms?
A. Decreased plasma oncotic pressure causing fluid shift
B. Increased pulmonary capillary hydrostatic pressure due to left ventricular failure
C. Increased alveolar permeability from inflammation
D. Decreased lymphatic drainage from the lungs
What is B. Increased pulmonary capillary hydrostatic pressure due to left ventricular failure?
This explains why hypertrophic cardiomyopathy murmur increases with Valsalva.
What is decreased preload increasing LV outflow obstruction?
A 58-year-old woman with chronic systolic heart failure is started on a new medication to improve survival. Several weeks later, she reports improved exercise tolerance. However, labs show mild hyperkalemia.
Which of the following medications was most likely started?
A. Furosemide
B. Metoprolol
C. Spironolactone
D. Sacubitril/valsartan
What is C. Spironolactone?
A 35-year-old man with dilated cardiomyopathy has the following hemodynamic measurements:
He also has elevated creatinine and signs of volume overload.
Which of the following best explains the simultaneous presence of fluid overload and decreased renal function in this patient?
A. Increased cardiac output leading to renal hyperfiltration
B. Decreased stroke volume causing reduced renal perfusion and compensatory fluid retention
C. Increased GFR leading to sodium retention
D. Decreased preload causing increased urine output
What is B. Decreased stroke volume causing reduced renal perfusion and compensatory fluid retention?
A 35-year-old man with dilated cardiomyopathy is treated with a neprilysin inhibitor/ARB combination (sacubitril/valsartan). After starting therapy, he develops mild hypotension but improved symptoms of congestion.
Which of the following best explains how this medication combination improves outcomes in heart failure?
A. Increases angiotensin II levels to improve renal perfusion
B. Enhances natriuretic peptide activity while blocking RAAS-mediated vasoconstriction
C. Directly increases myocardial contractility
D. Promotes aldosterone release to maintain blood pressure
What is B. Enhances natriuretic peptide activity while blocking RAAS-mediated vasoconstriction?
A 67-year-old man with known systolic heart failure (EF 25%) is admitted for worsening dyspnea, orthopnea, and leg swelling. On exam, he has elevated JVP, bilateral crackles, and 3+ pitting edema. Labs show BNP 1500 pg/mL and creatinine 1.8 mg/dL (baseline 1.2).
He is started on IV furosemide. Over the next 48 hours, he loses 6 kg of fluid and his breathing improves significantly. However, his creatinine rises to 2.3 mg/dL.
Which of the following best explains this patient’s worsening renal function despite appropriate treatment?
A. Decreased effective arterial blood volume leading to reduced renal perfusion
B. Intrinsic kidney injury due to furosemide toxicity
C. Increased aldosterone levels causing renal vasoconstriction
D. Increased cardiac output leading to hyperfiltration injury
What is A. Decreased effective arterial blood volume leading to reduced renal perfusion?
A 22-year-old man collapses while playing basketball. He regains consciousness shortly after. He reports occasional chest discomfort and shortness of breath with exertion over the past few months. His father died suddenly at age 40.
On physical exam, a systolic murmur is heard along the left sternal border that increases with Valsalva maneuver.
Echocardiogram shows asymmetric septal hypertrophy with preserved ejection fraction.
Which of the following is the most likely underlying pathophysiology?
A. Dilated ventricles with decreased contractility
B. Stiff ventricles with impaired filling
C. Dynamic left ventricular outflow tract obstruction due to septal hypertrophy
D. Increased preload leading to increased stroke volume
C. Dynamic left ventricular outflow tract obstruction due to septal hypertrophy
A 58-year-old woman with chronic systolic heart failure is started on a new medication to improve survival. Several weeks later, she reports improved exercise tolerance. However, labs show mild hyperkalemia.
A 64-year-old man with systolic heart failure (EF 30%) presents with worsening dyspnea, orthopnea, and leg swelling. On exam, he has crackles and 3+ pitting edema. He is given an IV medication and within hours begins producing large amounts of urine with improvement in his breathing.
Which of the following best describes the mechanism of action of this medication?
A. Inhibition of sodium reabsorption in the distal convoluted tubule
B. Inhibition of the Na-K-2Cl transporter in the thick ascending limb
C. Blockade of aldosterone receptors in the collecting duct
D. Inhibition of neprilysin leading to increased BNP
What is B. Inhibition of the Na-K-2Cl transporter in the thick ascending limb?