Cardiology Pg 326-335
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Questions and Answers

Which of the following is an initial treatment for acute decompensated heart failure?

  • Vasopressors
  • IV Diuretics (correct)
  • Vitamin C
  • Inotropic support

    • A narrow pulse pressure is a feature of cardiogenic shock.

    True

    What is the purpose of administering morphine in acute decompensated heart failure?

    To facilitate extravascular fluid shift.

    In the management of HFrEF, the most common inotropic agent used is __________.

    <p>Dobutamine</p> Signup and view all the answers

    Match the following conditions with their appropriate treatments:

    <p>HFrEF = Inotropic support HFPEF = Vasopressors Cardiogenic Shock = Intra-aortic balloon pump Acute Decompensated Heart Failure = IV Diuretics</p> Signup and view all the answers

    What is the recommended BNP level in patients that suggests a probability of heart failure (HF)?

    <blockquote> <p>900 pg/mL</p> </blockquote> Signup and view all the answers

    Obese patients typically have higher levels of BNP than non-obese patients.

    <p>False</p> Signup and view all the answers

    What therapy is preferred in acute aortic regurgitation (AR) or mitral regurgitation (MR) to decrease aortic pressure?

    <p>Nitroprusside</p> Signup and view all the answers

    In pulmonary edema patients with maintained BP who are not recovering, _____ or SCUF should be considered.

    <p>dialysis</p> Signup and view all the answers

    Match the following treatments with their specific conditions:

    <p>Dialysis = Pulmonary edema with maintained BP Nitroprusside = Acute AR/MR therapy BNP = Heart failure diagnosis SCUF = Fluid management in severe cases</p> Signup and view all the answers

    Which of the following is NOT a finding on an ECG for cardiomyopathy?

    <p>Left ventricular hypertrophy</p> Signup and view all the answers

    Peripartum cardiomyopathy is associated with a high recurrence risk.

    <p>True</p> Signup and view all the answers

    What percentage of acute decompensated heart failure (ADHF) cases are caused by prior heart failure?

    <p>80%</p> Signup and view all the answers

    Hypertensive ADHF is classified as the least common type of ADHF.

    <p>True</p> Signup and view all the answers

    What is the main pathological factor associated with peripartum cardiomyopathy?

    <p>SFLTI (Soluble fibrin-like tyrosine kinase 1)</p> Signup and view all the answers

    Name one patient-related factor that can increase the risk of acute decompensated heart failure.

    <p>Age or family history</p> Signup and view all the answers

    In cardiomyopathy, __________ is typically recommended for patients experiencing severe symptoms.

    <p>transplant</p> Signup and view all the answers

    ADHF often presents with __________ symptoms like a tender, enlarged liver.

    <p>right-sided congestive</p> Signup and view all the answers

    Match the following features with their appropriate categories:

    <p>ECG finding = Small voltage complexes in limb leads Echo finding = Large left ventricle Clinical feature = Worsening dyspnea Pathological factor = SFLTI</p> Signup and view all the answers

    Match the following types of ADHF with their description:

    <p>Mild to Moderate ADHF = Most common type, presents with underlying HFrEF and LRTI Hypertensive ADHF = Associated with controlled hypertension ADHF with acute pulmonary edema = Characterized by fluid accumulation in the lungs Cardiogenic shock = Severe form leading to inadequate blood flow to organs</p> Signup and view all the answers

    Which of the following is NOT an anthracycline?

    <p>Cyclophosphamide</p> Signup and view all the answers

    Trastuzumab is used in treating breast carcinoma and can induce cardiomyopathy.

    <p>True</p> Signup and view all the answers

    What are the common aggravating factors associated with alcohol-induced cardiomyopathy?

    <p>Thiamine, Magnesium, Selenium</p> Signup and view all the answers

    The most common cause of post-viral myocarditis is _____ virus.

    <p>HHV-6</p> Signup and view all the answers

    Match the following drug classes with their associated risks:

    <p>Anthracyclines = Non-Hodgkins lymphoma treatment Alcohol = Atrial fibrillation Cyclophosphamide = Hodgkins lymphoma treatment VEGF inhibitors = Anti-cancer therapies</p> Signup and view all the answers

    Which of the following symptoms is NOT typically associated with ADHF with acute pulmonary edema?

    <p>Uncontrolled hypertension</p> Signup and view all the answers

    Oral diuretics are typically the first-line treatment for hypertensive ADHF.

    <p>False</p> Signup and view all the answers

    What is the most common oral diuretic used in the management of acute decompensated heart failure?

    <p>Torsemide</p> Signup and view all the answers

    During an episode of ADHF with acute pulmonary edema, a patient may exhibit signs of ______ over all lung fields.

    <p>crepitations</p> Signup and view all the answers

    Match the symptoms of ADHF with acute pulmonary edema to their corresponding characteristics:

    <p>Acute breathlessness = Worsening over 60-90 minutes Diaphoresis = Signs of excessive sweating Tachypnea = Increased respiratory rate (&gt;130 bpm) Frothy sputum = Presence of fluid in airways</p> Signup and view all the answers

    Which of the following causes of cardiomyopathy has a good prognosis?

    <p>Alcohol-induced CMP</p> Signup and view all the answers

    Genetic factors account for approximately 50% of heart failure causes.

    <p>False</p> Signup and view all the answers

    What is the inheritance pattern of Dilated Cardiomyopathy (DCMP)?

    <p>Autosomal dominant</p> Signup and view all the answers

    Deficiencies in ______ can lead to toxin/nutrition induced CMP.

    <p>Thiamine</p> Signup and view all the answers

    Match the following types of cardiomyopathy with their inheritance patterns:

    <p>DCMP = Autosomal dominant ARVD = Autosomal recessive LV non compaction = X-linked recessive</p> Signup and view all the answers

    Which clinical feature is indicative of poor prognosis in a patient with infection?

    <p>Refractory hypotension</p> Signup and view all the answers

    Elevated Troponin I levels are associated with cardiomyopathy.

    <p>True</p> Signup and view all the answers

    What is the primary imaging technique that shows global or left ventricular dysfunction in cardiomyopathy?

    <p>ECHO</p> Signup and view all the answers

    The presence of _________ enhancement is a characteristic finding in MRI for myocarditis.

    <p>peripheral</p> Signup and view all the answers

    Match the following treatments with their indications:

    <p>Steroids = Autoimmune myocarditis Supportive care = General cardiomyopathy management No specific therapy = Overall treatment approach ECHO = Assessment of LV dysfunction</p> Signup and view all the answers

    What condition is indicated by the 'bat wing appearance' on a chest x-ray?

    <p>Cardiopulmonary Edema</p> Signup and view all the answers

    Cephalization of pulmonary vessels is the latest finding associated with pulmonary edema.

    <p>False</p> Signup and view all the answers

    Name one of the acute conditions that can lead to acute aortic regurgitation.

    <p>Aortic dissection</p> Signup and view all the answers

    Acute pulmonary edema with a PCWP elevated and CI normal is classified as ______.

    <p>Warm &amp; Wet</p> Signup and view all the answers

    Match the following lines seen on chest x-ray with their descriptions:

    <p>Kerley A lines = Fluid in the interlobular septa Kerley B lines = Dilated anastomotic channels between lymphatics Kerley C lines = Reticular opacities No lines = Normal pulmonary vasculature</p> Signup and view all the answers

    Which of the following is NOT a type of acute coronary syndrome?

    <p>Acute Aortic Regurgitation</p> Signup and view all the answers

    Bilateral renal artery stenosis can lead to splash pulmonary edema.

    <p>True</p> Signup and view all the answers

    What is often indicated by a LAP greater than 25 mm of Hg?

    <p>Acute Pulmonary Edema</p> Signup and view all the answers

    In cases of cold & dry pulmonary edema, the cardiac index (CI) is ______.

    <p>decreased</p> Signup and view all the answers

    Which inotropic drug is NOT mentioned for use in pulmonary edema with cardiogenic shock?

    <p>Vasopressin</p> Signup and view all the answers

    Which type of cardiomyopathy is characterized by structural dilatation of the left ventricle leading to systolic dysfunction?

    <p>Dilated cardiomyopathy (DCMP)</p> Signup and view all the answers

    All types of cardiomyopathy are caused by coronary artery disease.

    <p>False</p> Signup and view all the answers

    Name one symptom commonly associated with systolic heart failure in dilated cardiomyopathy.

    <p>Fatigue</p> Signup and view all the answers

    Dilated cardiomyopathy (DCMP) is a condition that primarily affects the _______ ventricle.

    <p>left</p> Signup and view all the answers

    Match the following types of cardiomyopathy with their features:

    <p>Dilated cardiomyopathy (DCMP) = Systolic heart failure Hypertrophic cardiomyopathy (HCM) = LV hypertrophy with potential obstruction Restrictive cardiomyopathy (RCMP) = Impaired diastolic filling Takotsubo cardiomyopathy = Stress-induced myocardial dysfunction</p> Signup and view all the answers

    Which of the following symptoms is indicative of diastolic heart failure?

    <p>Dyspnoea</p> Signup and view all the answers

    MRI is the gold standard for assessing left ventricular ejection fraction (EF).

    <p>True</p> Signup and view all the answers

    What percentage of all heart failure cases is attributed to dilated cardiomyopathy?

    <p>25%</p> Signup and view all the answers

    Study Notes

    Acute Decompensated Heart Failure (ADHF)

    Management

    • IV Diuretics: Commonly administer Furosemide (360 mg bolus).
    • Patient Positioning: Maintain a semi-recumbent position (45°) for comfort.
    • Oxygen Therapy: Administer high flow oxygen via Non-Rebreather Mask (NRBM) or Non-Invasive Ventilation (NIV).
    • Morphine: Administer 4 mg IV to assist with fluid redistribution.
    • Blood Pressure Control: Use Nitroglycerin (NTG) at 5 µg/min for management.

    Cardiogenic Shock

    Features

    • Narrow Pulse Pressure: Systolic Blood Pressure (SBP) below 90 mm Hg.
    • Symptoms: Fatigue, altered mental status, cyanosis, cold extremities.
    • Prognosis: Generally poor prognosis associated with these symptoms.

    Investigations

    • Lactic Acid Levels: To rule out occult shock.
    • Echocardiogram: Early assessment to exclude acute Aortic Regurgitation (AR) and Mitral Regurgitation (MR).

    Treatment

    Heart Failure with Reduced Ejection Fraction (HFrEF)

    • Inotropic Support: Dobutamine is commonly used; Milrinone serves as an inodilator.
    • Mechanical Support: Consider Intra-Aortic Balloon Pump (IABP) or Extracorporeal Membrane Oxygenation (ECMO).

    Heart Failure with Preserved Ejection Fraction (HFpEF)

    • Vasopressors: Administer vasopressin or Desmopressin as needed.

    Additional Notes

    • Patients with pulmonary edema and maintained BP may require dialysis or Slow Continuous Ultrasound Filtration (SCUF) via central/femoral catheter.
    • BNP and NT-ProBNP Levels: Indicate heart failure when > 900 pg/mL, less reliable in obesity.
    • Early Vasodilator Therapy: Nitroprusside preferred over NTG for acute AR/MR to reduce aortic pressure.

    Differential Diagnosis for ADHF

    • Acute Coronary Syndrome (ACS)
    • Acute Aortic and Mitral Regurgitation: Caused by dissection, infection, or other acute processes.
    • Myocarditis: Inflammatory heart disease.
    • Bilateral Renal Artery Stenosis: Can lead to splash pulmonary edema.
    • Takotsubo Cardiomyopathy: Stress-induced heart failure.

    Investigations in Pulmonary Edema

    • Chest X-ray: Not typically done in emergencies but can show "bat wing" appearance indicating cardiopulmonary edema and cephalization of pulmonary vessels.
    • Kerley Lines:
      • A Lines: 12-19 mm Hg; indicate lymphatic expansion.
      • B Lines: 20-24 mm Hg; represent fluid in interlobular septa.
      • C Lines: Pathological reticular opacities seen in significant volume overload.

    Acute Pulmonary Edema Features

    • Classification: Warm & dry versus cold & wet states based on patient presentation and pulmonary capillary wedge pressure (PCWP).
    • Signs of Congestion: Include tachypnea, hypertensive crisis, bilateral pulmonary crepitations, and frothy sputum.

    Risk Factors for ADHF

    • Prior heart failure, infections (especially lower respiratory tract infections), anemia, certain medications, myocardial infarction, atrial fibrillation, uncontrolled hypertension, and pregnancy.

    Classifications of ADHF

    • Mild to moderate ADHF, hypertensive ADHF, ADHF with acute pulmonary edema, and cardiogenic shock.

    Clinical Features of Mild to Moderate ADHF

    • Gradual onset of dyspnea, symptoms of right-sided heart failure (enlarged liver, edema), absence of pulmonary edema or cardiogenic shock, and signs such as S3 heart sound or cardiomegaly.

    Drug-Induced Cardiomyopathy

    • Chemotherapy Agents: Anthracyclines like Doxorubicin, Trastuzumab associated with breast cancer treatment.
    • Alcohol-Induced: Risk factors include ACE polymorphism, electrolyte deficiencies, and alcohol avoidance leads to improvement in ejection fraction.

    Myocarditis

    • Causes include viral infections like HHV-6 and Trypanosoma cruzi. It presents with acute symptoms and requires investigations such as ECG and echocardiography.

    Types of Cardiomyopathy

    • Dilated Cardiomyopathy (DCMP), Hypertrophic Cardiomyopathy (HCM), Restrictive Cardiomyopathy (RCMP), and their management varies based on etiology and symptoms.

    Peripartum Cardiomyopathy

    • Championed by high recurrence rates, occurring usually postpartum or in the third trimester. Classically associated with hypertension and specific biomarkers.

    Investigations for Cardiomyopathy

    • ECG: Low voltage in limb leads and sinus tachycardia; suggestive of underlying heart issues.
    • Echo: Can reveal cardiomegaly and hypokinesia of the left ventricle.
    • MRI: Useful for evaluating symptoms and ruling out coronary artery disease.

    Management of Cardiomyopathy

    • Treatment focuses on supportive measures; some cases may necessitate heart transplantation for severe dysfunction or complications.

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    Description

    This quiz covers the management strategies for Acute Decompensated Heart Failure and Cardiogenic Shock. Key interventions such as IV diuretics, oxygen therapy, and morphine administration are assessed, along with understanding the features of cardiogenic shock. Test your knowledge on these critical aspects of patient care.

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