Harrison's Hour - Heart Failure
Questions and Answers
- 1.
1. The measurement of this biomarker is useful for establishing prognosis or disease severity in chronic HF and can be useful to achieve optimal dosing of medical therapy in select clinically euvolemic patients. PAGE 1505
- A.
A. Soluble ST-2
- B.
B. Galectin-3
- C.
C. Troponin I
- D.
D. B-type natriuretic peptide
Correct Answer
D. D. B-type natriuretic peptideExplanation
The measurement of B-type natriuretic peptide (BNP) is useful for establishing prognosis or disease severity in chronic HF and can be useful to achieve optimal dosing of medical therapy in select clinically euvolemic patients. BNP is a hormone that is released by the heart in response to increased pressure and stretching of the heart muscle. Elevated levels of BNP indicate increased stress on the heart and can help in determining the severity of heart failure. Monitoring BNP levels can help in adjusting medication dosages to achieve optimal treatment outcomes.Rate this question:
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- 2.
2. A heterogenous clinical syndrome most often resulting in need for hospitalization due to confluence of interrelated abnormalities of decreased cardiac performance, renal dysfunction, and alteration in vascular compliance? PAGE 1507
- A.
A. Acute decompensated heart failure
- B.
B. Heart failure with reduce ejection fraction
- C.
C. Heart failure with preserve ejection fraction
- D.
D. Advanced heart failure
Correct Answer
A. A. Acute decompensated heart failureExplanation
Acute decompensated heart failure is the correct answer because it accurately describes the heterogenous clinical syndrome that leads to the need for hospitalization. This syndrome is characterized by a combination of decreased cardiac performance, renal dysfunction, and alteration in vascular compliance. The term "acute decompensated" indicates that the heart failure has worsened suddenly, leading to the need for immediate medical intervention.Rate this question:
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- 3.
3. What are the cardinal symptoms of HF? PAGE 1503
- A.
A. Fatigue and Orthopnea
- B.
B. SOB and Tachycardia
- C.
C. Fatigue and SOB
- D.
D. PND and Orthopnea
Correct Answer
C. C. Fatigue and SOBExplanation
Fatigue and shortness of breath (SOB) are the cardinal symptoms of heart failure (HF). Fatigue is a common symptom experienced by individuals with HF due to the decreased ability of the heart to pump blood effectively, leading to reduced oxygen and nutrient supply to the body's tissues. SOB occurs due to fluid accumulation in the lungs, causing difficulty in breathing. These symptoms are key indicators of HF and should be monitored and managed to prevent further complications.Rate this question:
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- 4.
4. How will you classify patient with HF describe as mild limitation of physical activity with symptoms occurring during ordinary activity? PAGE 1501
- A.
A. NYHA I
- B.
B. NYHA II
- C.
C. NYHA III
- D.
D. NYHA IV
Correct Answer
B. B. NYHA IIExplanation
The correct answer is b. NYHA II. This classification is based on the New York Heart Association (NYHA) functional classification system for heart failure. NYHA II represents mild limitation of physical activity, with symptoms occurring during ordinary activity. NYHA I represents no limitation of physical activity, NYHA III represents marked limitation of physical activity, and NYHA IV represents symptoms at rest.Rate this question:
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- 5.
5. What is the drug that exerts a mild inotropic effect, attenuate carotid sinus baroreceptor activity, and are sympathoinhibitory? PAGE 1512
- A.
A. Furosemide
- B.
B. Enalapril
- C.
C. Digoxin
- D.
D. Carvedilol
Correct Answer
C. C. DigoxinExplanation
Digoxin is the correct answer because it is a drug that exerts a mild inotropic effect, meaning it increases the force of contraction of the heart. It also attenuates carotid sinus baroreceptor activity, which helps to decrease the sensitivity of the baroreceptors and lower blood pressure. Additionally, digoxin has sympathoinhibitory effects, meaning it inhibits sympathetic nervous system activity. Furosemide is a diuretic, enalapril is an ACE inhibitor, and carvedilol is a beta blocker, none of which have the same effects as digoxin.Rate this question:
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- 6.
6. Which of the following causes depressed EF in HF? PAGE 1501
- A.
A. Hypertrophic Cardiomyopathy
- B.
B. Restrictive Cardiomyopathy
- C.
C. Dilated Cardiomyopathy
- D.
D. Thyrotoxicosis
Correct Answer
C. C. Dilated CardiomyopathyExplanation
Dilated cardiomyopathy is a condition characterized by the enlargement of the heart chambers, leading to weakened and stretched heart muscles. This can result in decreased contractility and impaired ejection fraction (EF), which is the percentage of blood pumped out of the heart with each contraction. Therefore, dilated cardiomyopathy can cause depressed EF in heart failure. Hypertrophic cardiomyopathy is characterized by thickened heart muscles but does not typically cause depressed EF. Restrictive cardiomyopathy involves stiffening of the heart muscles, which can also impair EF. Thyrotoxicosis, a condition caused by excessive thyroid hormone production, can lead to increased heart rate and contractility, which would not cause depressed EF.Rate this question:
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- 7.
7. What are the cornerstones of therapy of CHF? PAGE 1511
- A.
A. ACE-I and CCB
- B.
B. ACE-I and BB
- C.
C. ACE-I and Diuretics
- D.
D. ACE-I and ARBS
Correct Answer
B. B. ACE-I and BBExplanation
The cornerstones of therapy for congestive heart failure (CHF) are ACE inhibitors (ACE-I) and beta blockers (BB). ACE inhibitors help to reduce the workload on the heart by dilating blood vessels and reducing fluid buildup. Beta blockers help to slow the heart rate and improve the heart's pumping ability. Together, these medications can help to improve symptoms, reduce hospitalizations, and improve survival in patients with CHF.Rate this question:
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- 8.
8. First line of therapy in volume overload with congestion? Page 1510
- A.
A. Spironolactone
- B.
B. Eplerenone
- C.
C. Furosemide
- D.
D.Hydrochlorothiazide
Correct Answer
C. C. FurosemideExplanation
The first line of therapy in volume overload with congestion is Furosemide. Furosemide is a loop diuretic that works by inhibiting the reabsorption of sodium and chloride in the loop of Henle in the kidneys, leading to increased urine output and decreased fluid volume. It is commonly used to treat conditions such as congestive heart failure and edema. Spironolactone and Eplerenone are potassium-sparing diuretics that are typically used as adjunctive therapy in patients who are at risk for hypokalemia. Hydrochlorothiazide is a thiazide diuretic that is mainly used for hypertension and not typically the first choice for volume overload with congestion.Rate this question:
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- 9.
9. The following statement are TRUE regarding Cor Pulmonale, EXCEPT? PAGE 1505-1506
- A.
A. often referred as pulmonary heart disease
- B.
B. defined as altered RV structure and/or function in the context of chronic lung disease
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C. develops only in chronic changes in the pulmonary vasculature
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D. the most common cause of right HF is Left HF
Correct Answer
C. C. develops only in chronic changes in the pulmonary vasculatureExplanation
Cor Pulmonale, often referred to as pulmonary heart disease, is defined as altered RV structure and/or function in the context of chronic lung disease. It is not limited to developing only in chronic changes in the pulmonary vasculature. Other causes can include chronic obstructive pulmonary disease (COPD), pulmonary embolism, and sleep apnea. The most common cause of right heart failure (RHF) is actually left heart failure (LHF), not Cor Pulmonale.Rate this question:
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- 10.
10. It augurs a poor overall prognosis when present in patient with HF? Page 1504
- A.
A. peripheral edema
- B.
B. cardiac cachexia
- C.
C. ascites
- D.
D. jaundice
Correct Answer
B. B. cardiac cachexiaExplanation
Cardiac cachexia refers to the severe muscle wasting and weight loss that occurs in patients with advanced heart failure. It is a strong predictor of poor prognosis and is associated with increased mortality rates. The presence of cardiac cachexia indicates a more advanced stage of heart failure and suggests that the disease has progressed to a point where the body is unable to maintain adequate nutrition and muscle mass. Therefore, the presence of cardiac cachexia in a patient with heart failure indicates a poor overall prognosis.Rate this question:
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- 11.
11. Gold standard for assessing LV mass and volume? Page 1505
- A.
A. 12-L ECG
- B.
B. 2-D echo
- C.
C. Holter monitoring
- D.
D. MRI
Correct Answer
D. D. MRIExplanation
MRI is considered the gold standard for assessing left ventricular (LV) mass and volume because it provides detailed and accurate images of the heart. It allows for precise measurement of LV mass and volume, which are important indicators of heart function and can help diagnose and monitor conditions such as heart failure. MRI provides high-resolution images and can capture both anatomical and functional information about the heart, making it a reliable and comprehensive tool for assessing LV mass and volume.Rate this question:
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- 12.
12. The following conditions can also lead to HF with a preserved EF? Page 1501
- A.
A. Cor pulmonale
- B.
B. Myocardial infarction
- C.
C. Hypertension
- D.
D. Metabolic disorder
Correct Answer
C. C. HypertensionExplanation
Hypertension, or high blood pressure, can lead to heart failure with preserved ejection fraction (EF). This occurs when the heart muscle becomes stiff and is unable to relax properly, leading to decreased filling of the heart chambers and reduced blood flow. Hypertension causes increased pressure within the blood vessels, which can lead to structural changes in the heart over time. These changes can result in diastolic dysfunction, where the heart is unable to relax and fill properly during the resting phase of the cardiac cycle. This can ultimately lead to heart failure with preserved EF.Rate this question:
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- 13.
13. A condition wherein it refers to the changes in LV mass, volume, and shape and the composition of the heart that occur after cardiac injury and/or abnormal hemodynamic loading conditions. PAGE 1503
- A.
A. Ventricular remodeling
- B.
B. Elevated LV end-diastolic filling
- C.
C. LV hypertrophy
- D.
D. Myocardial ischemia
Correct Answer
A. A. Ventricular remodelingExplanation
Ventricular remodeling refers to the changes in the left ventricular (LV) mass, volume, shape, and composition that occur after cardiac injury and/or abnormal hemodynamic loading conditions. This process involves structural changes in the heart, such as hypertrophy (increase in muscle mass), dilation (increase in chamber size), and fibrosis (scarring). These changes can lead to impaired cardiac function and contribute to the progression of heart failure. Therefore, ventricular remodeling is the most appropriate explanation for the given condition.Rate this question:
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- 14.
14. A clinical manifestation of HF which results from redistribution of fluid from splanchnic circulation and lower extremities into central circulation during recumbency? Page 1503
- A.
A. Orthopnea
- B.
B. PND
- C.
C. Dyspnea
- D.
D. Platypnea
Correct Answer
A. A. OrthopneaExplanation
Orthopnea is a clinical manifestation of heart failure where there is difficulty breathing while lying flat. This occurs because when a person lies down, fluid that has accumulated in the splanchnic circulation and lower extremities is redistributed into the central circulation, including the lungs. This fluid accumulation in the lungs leads to shortness of breath and the need to sit or stand upright to alleviate the symptoms.Rate this question:
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- 15.
15. What is the cause of sudden cardiac death(SCD) in approximately half of patients with HF and is particularly prevalent in HFrEF patients with early stage of disease? PAGE 1514
- A.
A. ventricular arryhthmia
- B.
B. atrial fibrillation
- C.
C. LBBB
- D.
D. RBBB
Correct Answer
A. A. ventricular arryhthmiaExplanation
Ventricular arrhythmia is the cause of sudden cardiac death (SCD) in approximately half of patients with heart failure (HF), especially in HFrEF (heart failure with reduced ejection fraction) patients in the early stages of the disease. Ventricular arrhythmias are abnormal heart rhythms that originate in the ventricles, the lower chambers of the heart. These arrhythmias can disrupt the normal electrical activity of the heart and cause it to beat irregularly or stop altogether, leading to sudden cardiac death. Therefore, ventricular arrhythmia is a significant concern in patients with HF and can contribute to their increased risk of SCD.Rate this question:
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- 16.
16. It provides estimation of Right atrial pressure? PAGE 1504
- A.
A. JVP
- B.
B. PP
- C.
C. MAP
- D.
D. SV
Correct Answer
A. A. JVPExplanation
The correct answer is JVP. JVP stands for Jugular Venous Pressure, which is a measurement used to estimate the pressure in the right atrium of the heart. By assessing the height of the jugular venous pulsations, healthcare professionals can determine the pressure in the right atrium, which can be indicative of various cardiovascular conditions. Therefore, JVP provides an estimation of right atrial pressure.Rate this question:
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- 17.
17. All are true about Cheyne-Stokes respiration EXCEPT? PAGE 1504
- A.
A. Referred as periodic respiration
- B.
B. Usually assoc. with low cardiac output
- C.
C. Increased sensitivity of the respiratory center to arterial O2
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D. Stimulate the respiratory center resulting in hyperventilation, hypocapnia, followed by recurrence of apnea
Correct Answer
C. C. Increased sensitivity of the respiratory center to arterial O2Explanation
Cheyne-Stokes respiration is a type of periodic respiration characterized by alternating periods of hyperventilation and apnea. It is usually associated with low cardiac output and is caused by a decreased sensitivity of the respiratory center to arterial oxygen levels. This decreased sensitivity leads to a delayed response in adjusting the respiratory rate, resulting in the characteristic pattern of Cheyne-Stokes respiration. Therefore, option c, which states increased sensitivity of the respiratory center to arterial oxygen, is incorrect.Rate this question:
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- 18.
18. What is the treatment that has been shown to be associated with modestly improved clinical outcomes in patients with HFrEF? PAGE 1513
- A.
A. Omega-3 polyunsatureted fatty acids
- B.
B. Rosuvastatin
- C.
C. Aspirin
- D.
D. Amlodipine
Correct Answer
A. A. Omega-3 polyunsatureted fatty acidsExplanation
Omega-3 polyunsaturated fatty acids have been shown to be associated with modestly improved clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF). These fatty acids have anti-inflammatory and antiarrhythmic properties, and they may also improve endothelial function and reduce oxidative stress. Several clinical trials have demonstrated that omega-3 supplementation can reduce mortality and hospitalizations in patients with HFrEF. Therefore, omega-3 polyunsaturated fatty acids are recommended as a treatment option for patients with HFrEF.Rate this question:
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- 19.
19. The following Beta-blockers should restrictedly use in HFrEF, EXCEPT? PAGE 1511
- A.
A. carvedilol
- B.
B. propranolol
- C.
C. metoprolol succinate
- D.
D. bisoprolol
Correct Answer
B. B. propranololExplanation
Propranolol is not recommended for use in patients with heart failure with reduced ejection fraction (HFrEF) because it has negative inotropic effects and can worsen heart failure symptoms. Carvedilol, metoprolol succinate, and bisoprolol are all beta-blockers that have been shown to improve outcomes in patients with HFrEF and are recommended for use in this population.Rate this question:
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- 20.
20. What is the procedure considered in patients with ischemic cardiomyopathy with multivessel coronary artery disease? PAGE 1514
- A.
A. Coronary angioplasty
- B.
B. Coronary angiography
- C.
C. Coronary artery bypass grafting
- D.
D. Optimal medical therapy
Correct Answer
C. C. Coronary artery bypass graftingExplanation
Patients with ischemic cardiomyopathy and multivessel coronary artery disease are often recommended to undergo coronary artery bypass grafting (CABG). This procedure involves taking a healthy blood vessel from another part of the body, usually the leg or chest, and using it to bypass the blocked or narrowed coronary arteries. By doing so, blood flow to the heart muscle is restored, reducing symptoms and improving overall heart function. CABG is considered a more effective treatment option compared to coronary angioplasty or optimal medical therapy alone in these patients.Rate this question:
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