Heart Failure Additional Studies

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What is the epidemiologic magnitude of congestive heart failure (CHF)?

Low morbidity and mortality rates

Primary diagnosis of acutely compensated heart failure

Decreasing incidence and prevalence

Approximately 1 million US hospital admissions per year (correct)

How is systolic dysfunction characterized in heart failure (HF)?

Constricted left ventricle with normal contractility

Constricted left ventricle with impaired contractility

Dilated left ventricle with impaired contractility (correct)

Dilated left ventricle with relaxed muscles

Which New York Heart Association's functional classification of CHF describes a patient who is not limited with normal physical activity by symptoms?

Class IV

Class II

Class III

Class I (correct)

What is diastolic dysfunction in heart failure (HF) characterized by?

Dilated left ventricle with impaired ability to relax and receive blood Signup and view all the answers

What is the primary cause of acutely decompensated heart failure?

Impaired contractility of the left ventricle Signup and view all the answers

What does the functional classification of Class III in CHF mean?

Marked limitation in normal physical activity Signup and view all the answers

What is the prevalence rate of CHF?

1-2% Signup and view all the answers

Which neurohormonal response is released by cardiac myocytes in response to cardiac injury?

Tumor necrosis factor (TNF) Signup and view all the answers

What is the leading diagnosis-related group (DRG) among hospitalized patients older than 65 years?

CHF Signup and view all the answers

What is the 1-year survival rate after diagnosis of CHF?

75.9% Signup and view all the answers

In pulmonary edema, what causes alveolar flooding to occur?

Increased intracapillary pressure Signup and view all the answers

Which type of heart failure is characterized by decreased contractility?

Systolic failure Signup and view all the answers

What is the ejection fraction (EF) range for heart failure with reduced ejection fraction (HFrEF)?

<40% Signup and view all the answers

What compensatory mechanism promotes venous and arterial vasodilation, reduces preload, and reduces afterload?

Natriuretic peptides Signup and view all the answers

What does the Frank-Starling mechanism state about cardiac dilatation during diastole?

It increases the subsequent force and volume of systolic contraction and ejection. Signup and view all the answers

What is the primary cause of death in patients with heart failure?

Progressive heart failure Signup and view all the answers

What is the main purpose of the compensation mechanisms in heart failure?

To maintain cardiac output when stroke volume is reduced Signup and view all the answers

Which ethnic group has a higher likelihood of dying from CHF compared to whites?

Blacks Signup and view all the answers

Which test is helpful when there is diagnostic uncertainty in heart failure and to evaluate for underlying cause?

Cardiac MRI Signup and view all the answers

What is the initial therapy for patients with hypertensive acute heart failure?

Vasodilators Signup and view all the answers

Which medication is contraindicated in patients with systolic blood pressure (SBP) less than 100 mm Hg?

Nitrates Signup and view all the answers

What is the goal of pharmacotherapy in the treatment of decompensated congestive heart failure (CHF) and pulmonary edema?

Achieve a PCWP of 15-18 mm Hg Signup and view all the answers

Which medication may rapidly reverse hemodynamic instability and symptoms in patients with elevated blood pressure?

ACE inhibitors Signup and view all the answers

What is the most appropriate initial therapy if a patient presents with acute pulmonary edema with a systolic blood pressure of at least 100 mm Hg?

Nitrates Signup and view all the answers

Which medication reduces preload and systemic vascular resistance (SVR) and increases cardiac output in acute therapy?

Opioids Signup and view all the answers

"To reduce venous return, elevate the head of the bed" - Which medication is most appropriate to achieve this effect?

"Non invasive positive pressure ventilation" Signup and view all the answers

"In addition to being both an anxiolytic and an analgesic, its most important effect is venodilation, which reduces preload" - Which medication does this statement refer to?

"Opioids" Signup and view all the answers

Which test might not always be part of the standard workup for heart failure, but can be helpful when there is diagnostic uncertainty?

NT-proBNP Signup and view all the answers

What is the initial dosing of Furosemide (Lasix) for patients symptomatic with CHF not already using diuretics?

20-40 mg IV Signup and view all the answers

What is the most common cause of acute deterioration of cardiac function leading to cardiogenic shock?

Chronic decline of the contractile performance of the heart Signup and view all the answers

Which combination of clinical manifestations is suggestive of significant right ventricular infarction, massive pulmonary embolism, or cardiac tamponade?

Clear chest, profound hypotension, neck vein distension Signup and view all the answers

Which diagnostic test is particularly useful in determining the regional and global ventricular function, presence of pericardial effusion, and severe acute valvular diseases?

Echocardiography Signup and view all the answers

Which statement about the natural history of cardiogenic shock complicating acute myocardial infarction is true?

The mortality rate is at least 60 to 70% in most medical centers. Signup and view all the answers

What is the primary therapy for cardiogenic shock directed at?

Addressing the underlying defect Signup and view all the answers

In the presence of cardiogenic shock due to inotropic failure of the left ventricle without profound hypotension, what should be administered to increase stroke volume?

Dobutamine Signup and view all the answers

What nonpharmacologic therapy allows the heart to rest and is used for patients with cardiogenic shock?

Intraaortic balloon pump (IABP) therapy Signup and view all the answers

What is the indication for ventricular assist device (VAD) therapy?

Bridge to recovery or cardiac transplantation Signup and view all the answers

What does chronic heart failure (HF)-End Stage >ADHF refer to?

(New York Heart Association Classification IV who have failed medical therapy) Signup and view all the answers

Which nonpharmacologic therapy involves wrapping the latissimus dorsi around the heart?

Cardiomyoplasty Signup and view all the answers

What medication should be administered only for treatment of sustained, hemodynamically significant arrhythmias due to its negative inotropic action?

Antiarhythmic agents Signup and view all the answers

Which combination of clinical manifestations indicates significant right ventricular infarction, massive pulmonary embolism, or cardiac tamponade?

Clear chest, profound hypotension, neck vein distension Signup and view all the answers

Which of the following is NOT a common congestive symptom of heart failure?

Weight loss Signup and view all the answers

What is the most common dysrhythmia associated with heart failure?

Atrial fibrillation Signup and view all the answers

Which of the following physical findings is NOT associated with right heart failure?

Decreased exercise tolerance Signup and view all the answers

What is the term for the alternating weak and strong pulse indicative of depressed left ventricle function?

Pulsus alternans Signup and view all the answers

Which condition is characterized by acute pulmonary edema and may present with symptoms such as cool and clammy skin, tachycardia, and frothy, blood-tinged sputum?

Acute decompensated heart failure (ADHF) Signup and view all the answers

What is the most useful point-of-care test for identifying heart failure?

Brain natriuretic peptide (BNP) Signup and view all the answers

Which imaging study can assess ventricular function, size, wall motion, valve function, and help identify the etiology of heart failure?

Transthoracic echocardiography Signup and view all the answers

Which laboratory value is suggestive of a congestive hepatopathy in heart failure?

Elevated alanine aminotransferase (ALT) Signup and view all the answers

What is the classic pattern of pulmonary edema observed on chest radiography reflecting a pulmonary capillary wedge pressure (PCWP) of more than 25 mm Hg?

Butterfly pattern Signup and view all the answers

What is the term for the nonspecific tool that may be useful in diagnosing concomitant cardiac ischemia, prior myocardial infarction (MI), cardiac dysrhythmias, or left ventricular hypertrophy?

Electrocardiography (ECG) Signup and view all the answers

Which medication is recommended as a replacement for ACE inhibitors in patients with HFrEF who remain symptomatic despite optimal treatment with ACE-I, beta-blocker, and MRA?

Sacubitril/Valsartan (ARNI) Signup and view all the answers

What is the primary protective effect of SGLT2 inhibitors in heart failure?

Reduction in preload and afterload Signup and view all the answers

Which medication is recommended for patients with stable symptomatic HFrEF to reduce the risk of hospitalization and death?

Beta-blockers (carvedilol, bisoprolol, metoprolol succinate) Signup and view all the answers

What is the role of beta-blockers in the acute setting for patients with heart failure?

Currently unclear Signup and view all the answers

What is the primary mechanism of action of Ivabradine in heart failure?

Prolonging diastolic time and reducing heart rate Signup and view all the answers

Which drug class is not recommended for patients with heart failure due to its association with worsening heart failure?

Thiazolidindiones (Glitazones) Signup and view all the answers

What is the suggested activity modification for a patient in the severe stage of heart failure?

Bed rest with elevation of head of bed and anti-embolism stockings Signup and view all the answers

Which complication is most commonly seen in patients with significantly depressed left ventricular function?

Ventricular arrhythmias Signup and view all the answers

What is the primary hemodynamic criterion for cardiogenic shock?

Systolic arterial pressure < 90 mmHg Signup and view all the answers