Cardiology Pg 326-335

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 __________.

Dobutamine Signup and view all the answers

Match the following conditions with their appropriate treatments:

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

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

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

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

False Signup and view all the answers

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

Nitroprusside Signup and view all the answers

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

dialysis Signup and view all the answers

Match the following treatments with their specific conditions:

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

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

Left ventricular hypertrophy Signup and view all the answers

Peripartum cardiomyopathy is associated with a high recurrence risk.

True Signup and view all the answers

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

80% Signup and view all the answers

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

True Signup and view all the answers

What is the main pathological factor associated with peripartum cardiomyopathy?

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

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

Age or family history Signup and view all the answers

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

transplant Signup and view all the answers

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

right-sided congestive Signup and view all the answers

Match the following features with their appropriate categories:

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

Match the following types of ADHF with their description:

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 Signup and view all the answers

Which of the following is NOT an anthracycline?

Cyclophosphamide Signup and view all the answers

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

True Signup and view all the answers

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

Thiamine, Magnesium, Selenium Signup and view all the answers

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

HHV-6 Signup and view all the answers

Match the following drug classes with their associated risks:

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

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

Uncontrolled hypertension Signup and view all the answers

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

False Signup and view all the answers

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

Torsemide 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.

crepitations Signup and view all the answers

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

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

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

Alcohol-induced CMP Signup and view all the answers

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

False Signup and view all the answers

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

Autosomal dominant Signup and view all the answers

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

Thiamine Signup and view all the answers

Match the following types of cardiomyopathy with their inheritance patterns:

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

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

Refractory hypotension Signup and view all the answers

Elevated Troponin I levels are associated with cardiomyopathy.

True Signup and view all the answers

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

ECHO Signup and view all the answers

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

peripheral Signup and view all the answers

Match the following treatments with their indications:

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

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

Cardiopulmonary Edema Signup and view all the answers

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

False Signup and view all the answers

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

Aortic dissection Signup and view all the answers

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

Warm & Wet Signup and view all the answers

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

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 Signup and view all the answers

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

Acute Aortic Regurgitation Signup and view all the answers

Bilateral renal artery stenosis can lead to splash pulmonary edema.

True Signup and view all the answers

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

Acute Pulmonary Edema Signup and view all the answers

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

decreased Signup and view all the answers

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

Vasopressin Signup and view all the answers

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

Dilated cardiomyopathy (DCMP) Signup and view all the answers

All types of cardiomyopathy are caused by coronary artery disease.

False Signup and view all the answers

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

Fatigue Signup and view all the answers

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

left Signup and view all the answers

Match the following types of cardiomyopathy with their features:

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 Signup and view all the answers

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

Dyspnoea Signup and view all the answers

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

True Signup and view all the answers

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

25% 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.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

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.