Cardiology Pg 316-325
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Questions and Answers

What is the definitive treatment for symptomatic aortic regurgitation?

  • Medication management
  • Cardiovascular rehabilitation
  • Aortic valve replacement surgery (correct)
  • Observation and follow-up

    • Aortic regurgitation can be asymptomatic even when left ventricular failure is present.

    True

    What happens to left atrial pressure (LAP) during acute aortic regurgitation?

    25 mmHg

    The causes of acute aortic regurgitation include aortic dissection, infective endocarditis, and ruptured ________ of Valsalva.

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

    Match the following features with their respective characteristics in acute aortic regurgitation:

    <p>Cardiogenic shock = LV Failure Hypotension = Decreased systemic perfusion Pulmonary Edema = Fluid accumulation in the lungs NTG = Awaiting surgery treatment</p> Signup and view all the answers

    What does HFrEF stand for in the context of heart failure?

    <p>Heart Failure with Reduced Ejection Fraction</p> Signup and view all the answers

    Angina is categorized under the NYHA classification symptoms.

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

    What are the structural and functional disorders associated with heart failure?

    <p>Structural: LVH; Functional: Arrhythmia (e.g., Atrial Fibrillation)</p> Signup and view all the answers

    In NYHA Class _____, patients experience symptoms even at rest.

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

    Match the following NYHA class to their criteria:

    <p>Class I = Symptoms with ordinary physical activity Class II = Symptoms with more than ordinary activity Class III = Symptoms with less than ordinary activity Class IV = Symptoms with rest</p> Signup and view all the answers

    What stage of heart failure is characterized by no symptoms and risk factors such as hypertension and diabetes mellitus?

    <p>Stage A</p> Signup and view all the answers

    Patients in Stage D of heart failure respond well to medical therapy.

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

    What is the most common clinical feature associated with systolic heart failure?

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

    In Stage C heart failure, patients are often _____.

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

    Match each clinical feature to its corresponding description:

    <p>S3 heart sound = Indicates fluid overload or heart failure Cyanosis = Bluish discoloration due to inadequate oxygenation Pulsus alternans = Alternating strong and weak pulse Narrow pulse pressure = Difference between systolic and diastolic BP is small</p> Signup and view all the answers

    What is the effect of Angiotensin II in the RAAS system?

    <p>Vasoconstriction, increasing afterload</p> Signup and view all the answers

    ADH primarily causes the excretion of salt and water.

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

    Name one common beta blocker used in the treatment of heart failure.

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

    Natriuretic peptides inhibit _____ and _____ systems.

    <p>RAAS, sympathetic</p> Signup and view all the answers

    Match the drug class with their action:

    <p>Beta Blockers = Blocks sympathetic system ACE Inhibitors = Prevents conversion of angiotensin I to II Natriuretic Peptides = Excrete salt and water Neprilysin Inhibitors = Degrades natriuretic peptides</p> Signup and view all the answers

    What is the most common cause of right heart failure?

    <p>Left heart failure</p> Signup and view all the answers

    Increased right atrial pressure leads to decreased venous pressure.

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

    Name two signs or symptoms of right heart failure.

    <p>Edema, ascites</p> Signup and view all the answers

    The site of palpation for the abdominojugular reflex is the ______.

    <p>periumbilical area</p> Signup and view all the answers

    Match the following conditions with their respective characteristics:

    <p>Dilated cardiomyopathy = Most common cause is genetic Ischemic cardiomyopathy = Occurs post MI or CAD Valvular heart disease = Includes severe AR and AS Congenital heart disease = Structural heart defects present at birth</p> Signup and view all the answers

    Which of the following is the predominant symptom in heart failure?

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

    Pulmonary capillary venous pressure (PCVP) decreases in diastolic failure.

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

    What happens to left atrial pressure (LAP) in diastolic failure?

    <p>It increases.</p> Signup and view all the answers

    Patients with heart failure may experience _______ after lying down for 2-3 hours.

    <p>paroxysmal nocturnal dyspnea</p> Signup and view all the answers

    Match the following symptoms with their descriptions:

    <p>Orthopnea = Dyspnea immediately after lying down PND = Dyspnea after 2-3 hours of lying down Crackles = Acute presentation indicating fluid overload Pleural effusion = Fluid accumulation in the pleural cavity</p> Signup and view all the answers

    What is the most common comorbidity associated with heart failure with preserved ejection fraction (HFNEF)?

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

    Atrial fibrillation is more common in patients with heart failure with reduced ejection fraction (HFrEF) than in HFNEF.

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

    Name one drug class that can lead to decompensation in heart failure.

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

    In heart failure with reduced ejection fraction (HFrEF), myocardial ischemia can be an index event that leads to ________.

    <p>heart failure</p> Signup and view all the answers

    Match the compensatory mechanisms in heart failure with their effects:

    <p>Increased sympathetic activity = Increased heart rate Increased contractility = Enhanced pumping ability Arrhythmias = Irregular heart rhythms Increased blood volume = Fluid retention</p> Signup and view all the answers

    What condition is characterized by dyspnea that is greater than cough?

    <p>Heart Failure</p> Signup and view all the answers

    Bendopnea is the term used to describe breathlessness that occurs when lying down on one side.

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

    What happens to left atrial pressure (LAP) in heart failure with preserved ejection fraction?

    <p>It increases.</p> Signup and view all the answers

    Trepopnea refers to breathlessness when lying on the ______ side.

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

    Match the following terms with their definitions:

    <p>Bendopnea = Breathlessness upon bending forward Trepopnea = Breathlessness on lying down on one side Platypnea = Breathlessness upon standing up Pulmonary edema = Fluid accumulation in lung tissue</p> Signup and view all the answers

    What is the primary characteristic of an Austin Flint murmur?

    <p>Low pitched and mid-diastolic</p> Signup and view all the answers

    The Corrigan sign is characterized by weak carotid pulsations.

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

    What sign is described as head nodding with the heartbeat?

    <p>Alfred de Musset sign</p> Signup and view all the answers

    An ejection systolic murmur is typically heard at the ________ of the heart.

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

    Match the following peripheral signs to their descriptions:

    <p>Corrigan sign = Prominent carotid and supraclavicular pulsations Alfred de Musset sign = Head nodding with heartbeat</p> Signup and view all the answers

    What are the components of ARNI?

    <p>Angiotensin Receptor blocker and Neprilysin Inhibitor</p> Signup and view all the answers

    Natriuretic peptides prevent the degradation of Angiotensin II.

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

    Name one member of the 'Fantastic 4' used in the treatment of heart failure.

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

    If a patient is not _____, diuretics should be used first.

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

    Match the following treatments to their indications:

    <p>Cardiac resynchronization therapy = With wide QRS Implantable cardioverter defibrillator (ICD) = With normal QRS Diuretics = To relieve congestion</p> Signup and view all the answers

    Study Notes

    Aortic Regurgitation Management

    • Symptomatic AR requires aortic valve replacement surgery.
    • Asymptomatic severe AR indicated by LV failure; utilize the SS-50 rule: EF ≤ 55% and LVEDD ≥ 50%.
    • Acute AR causes include aortic dissection (chest pain), infective endocarditis, rupture of the sinus of Valsalva (right heart failure), and trauma.
    • Acute regurgitation leads to increased left ventricular end-diastolic pressure (LVEDP), resulting in pulmonary edema and LV failure.

    Heart Failure Overview

    • Defined as a complex clinical syndrome with structural or functional cardiac disorders impairing the ventricle's ability to pump blood.
    • Structural issues may include left ventricular hypertrophy (LVH) while functional may involve arrhythmias like atrial fibrillation.

    Heart Failure Classification

    • Types include HFrEF (reduced EF < 40%), HFpEF (preserved EF ≥ 50%), HFMEF (mid-range EF 40-50%), and ADHF (acute decompensated heart failure).

    NYHA Classification

    • Class I: Symptoms with ordinary activity, negligible mortality.
    • Class II: Symptoms with ordinary physical activity, risk of sudden cardiac death.
    • Class III: Symptoms with less than ordinary activity.
    • Class IV: Symptoms at rest, indicative of severe LV failure.

    Stages of Heart Failure

    • Stage A: No symptoms, only risk factors (e.g., hypertension, diabetes).
    • Stage B: No symptoms, structural heart disease present (e.g., LVH following hypertension).
    • Stage C: Most common stage, symptomatic patients.
    • Stage D: Refractory heart failure, unresponsive to medical therapy.

    HFrEF Clinical Features

    • Symptoms of systolic failure due to decreased cardiac output include fatigue, decreased urine output, cool extremities, cyanosis, altered mentation, and cardiomegaly.
    • S3 heart sound may be present, indicating dilated LV.

    RAAS and ADH in Heart Failure

    • RAAS activation leads to vasoconstriction and increased afterload, while aldosterone promotes sodium and water retention.
    • ADH causes free water retention leading to hyponatremia, while natriuretic peptides inhibit RAAS and promote salt and water excretion.

    Heart Failure Treatment

    • Treatment logic involves blocking pathways of sympathetic activity, RAAS, and the degradation of natriuretic peptides.
    • Beta blockers (e.g., metoprolol, bisoprolol, carvedilol) reduce sympathetic overactivity.
    • ACE inhibitors (e.g., ramipril, perindopril) and ARBs offer a class effect in management.

    Diastolic Failure Symptoms

    • Characterized by concentric LVH and insufficient dilation, leading to increased end-systolic volume and elevated pressures (LVEDP, LAP).
    • Dyspnea is a predominant symptom, often associated with pulmonary congestion and may present as orthopnea or paroxysmal nocturnal dyspnea.

    Right Heart Failure Overview

    • Most commonly due to left heart failure, resulting in increased right ventricle end-diastolic pressure (RVEDP).
    • Signs include abdominojugular reflex, ascites, edema, hepatomegaly, and increased jugular venous pressure.

    Common Causes of Heart Failure

    • Dilated cardiomyopathy (often genetic), ischemic cardiomyopathy (post-myocardial infarction), valvular heart disease (severe AR, AS, MR), and congenital heart disease.

    Framingham Diagnostic Criteria

    • Major criteria include acute pulmonary edema, cardiomegaly, and jugular venous pressure.
    • Minor criteria include ankle edema, dyspnea on exertion, and nocturnal cough.

    HFpEF/HFNEF Pathophysiology

    • Driven by comorbidity-related microvascular inflammation leading to left ventricular dysfunction and diastolic dysfunction, often resulting in atrial fibrillation.

    Key Terminology

    • Bendopnea: Symptoms worsen upon bending due to increased venous return.
    • Trepopnea: Difficulty breathing when lying on one side, often preferring the right side.
    • Platypnea: Breathlessness when upright, relieved by lying down.

    Refractory Heart Failure Management

    • Includes ARNI with beta blockers as first-line therapy; consideration of diuretics if patient is not euvolemic.
    • If symptomatic, consider advanced therapies like cardiac resynchronization therapy or implantable devices depending on QRS width.

    Fantastic Four for Heart Failure

    • ARNI, beta blocker, aldosterone antagonist (e.g., finerenone), and SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin) provide mortality benefits.

    Heart Failure with Renal Failure

    • Managed with hydralazine and nitrates to address congestion while considering diuretic therapy and subsequently introducing beta-blockers.

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    Description

    Test your knowledge on the management of aortic regurgitation, including the symptoms and treatment options for both symptomatic and asymptomatic cases. Explore the causes and pathology of acute aortic regurgitation, along with vital thresholds like the SS-50 rule. This quiz is designed for medical students and professionals seeking to reinforce their understanding of cardiac conditions.

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