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Question 1
Ten year survival after the onset of heart failure:
? 80-90%
? 60-79%
? 40-59%
? 20-39%
? Under 20%
Prognosis in Heart Failure
Men over 45 years of Age
Prognosis in Heart Failure
Women over 45 years of Age
Question 2
Potential underlying causes of heart failure include:
? Coronary artery disease
? Hemochromatosis
? Mitral regurgitation
? Ventricular septal defect
? all of the above
Heart Failure
The Final Common Pathway
* ischemic disease
* valvular disease
* cardiomyopathy
* pericardial disease
* hypertension
* congenital
Question 3
The pathophysiology of heart failure can best be described as:
? a failure of protective mechanisms
? activation of harmful pathways
? introduction of pathogenic influences
? inappropriate activation of normal mechanisms
? all of the above
Physiologic Response to Heart Failure
Question 4
Physiologic effects of Angiotensin II include:
? vasoconstriction
? activation of thirst
? sodium retention
? aldosterone release
? all of the above
Renin-Angiotensin System
Question 5
The following is a feature of the heart failure state:
? reduced circulating catecholamines
? increased left ventricular end diastolic pressure
? reduced plasma volume
? increased renal sodium excretion
? reduced pulmonary capillary wedge pressure
Compensatory Mechanisms in Heart Failure
* increased preload
* increased sympathetic tone
* increased circulating catecholamines
* increased Renin-angiotensin-aldosterone
* increased vasopressin
* increased atrial natriuretic factor
Question 6
Patients with early heart failure typically present with:
? No symptoms
? Dyspnea on exertion only
? Dyspnea with minimal activity
? Dyspnea at rest
? Acute respiratory distress
Heart Failure
Clinical Manifestations
Symptoms
* dyspnea
* fatigue
* exertional limitation
* weight gain
* poor appetite
* cough
Signs
* tachycardia, tachypnea
* edema
* jugular venous distension
* pulmonary rales
* pleural effusion
* hepato/splenomegaly
* ascites
* cardiomegaly
* S3 gallop
Dyspnea
Clinical Presentations
* exertional shortness of breath
* cough
* orthopnea
* paroxyxmal nocturnal dyspnea
* severe respiratory distress
* respiratory failure
NYHA Functional Classification
* Class I: patients with cardiac disease but no limitation of physical activity
* Class II: ordinary activity causes fatigue, palpitations, dyspnea or anginal pain
* Class III: less than ordinary activity causes fatigue, palpitations, dyspnea or angina
* Class IV:symptoms even at rest
Question 7
Edema in heart failure takes the following form:
? Peripheral edema
? Sacral edema
? Abdominal distention
? anasarca
? Any of the above
Edema
Clinical Presentations
* where - peripheral, sacral, generalized
* objective weight gain
* bloating
* abdominal distension
Question 8
Signs of right heart failure include all the following except:
? Peripheral edema
? Pulmonary rales
? Elevated jugular veins
? hepatomegaly
? Pleural effusions
Left vs Right Heart Failure
Left Heart Failure
* pulmonary congestion
Right Heart Failure
* peripheral edema
* sacral edema
* elevated JVP
* ascites
* hepatomegaly
* splenomegaly
* pleural effusion
Question 9
A diagnosis of heart failure is best extablished on the basis of the following:
? Dyspnea at rest, increased heart size on chest X ray and elevated jugular veins
? Dyspnea with stair climbing, increased heart size on chest X ray and heart rate of 105
? Rest dyspnea, interstitial edema on chest X ray,and elevated jugular veins
? Orthopnea, flow redistribution on chest X Ray, and crackles in lung bases
? PND, bilateral pleural effusions and crackles in lung bases
Criteria for Diagnosis of CHF
HISTORY Points
rest dyspnea4
orthopnea4
PND3
dyspnea walking on level2
dyspnea on climbing1
CHEST X-Ray
alveolar pulmonary edema4
interstitial pulm edema3
bilateral pleural effusion3
CT ratio > 0.503
flow redistribution2
PHYSICALPoints
HR 91-1101
HR > 1102
JVP > 6 cm2
JVP > 6 cm & hepatom3
lung crackles in base1
lung crackles above base2
wheezing3
S33
Question 10
All the following medications can precipitate heart failure in susceptible patient except:
? metoprolol
? spironolactone
? procainamide
? diltiazem
? rosiglitazone
Precipitating Causes of Heart Failure
Question 11
The following investigations should always be carried out in patient presenting with heart failure except:
? Renal function tests
? A ventilation-perfusion scan
? Blood counts
? Electrocardiogram
? Echocardiogram
Investigations for Heart Failure
* EKG
* evidence of ischemia, infarction, LVH, RVH
* rhythm analysis
* Chest X-Ray
* cardiac size
* evidence of pulmonary vascularity
* Blood work
* CBC, renal function, electrolytes
* Assessment of LV Function
Question 12
Patient A.B. presents with clear signs of left heart failure and responds quickly to standard therapy.Follow-up assessment reveals normal LV systolic function.The most likely underlying cause of this patient's heart failure is:
? Diastolic dysfunction
? Mitral valve disruption
? Pulmonary embolism
? Dilated cardiomyopathy
? Ischemic heart disease
Heart Failure with Normal LV systolic function between symptomatic episodes......（后略) ......
Question 1
Ten year survival after the onset of heart failure:
? 80-90%
? 60-79%
? 40-59%
? 20-39%
? Under 20%
Prognosis in Heart Failure
Men over 45 years of Age
Prognosis in Heart Failure
Women over 45 years of Age
Question 2
Potential underlying causes of heart failure include:
? Coronary artery disease
? Hemochromatosis
? Mitral regurgitation
? Ventricular septal defect
? all of the above
Heart Failure
The Final Common Pathway
* ischemic disease
* valvular disease
* cardiomyopathy
* pericardial disease
* hypertension
* congenital
Question 3
The pathophysiology of heart failure can best be described as:
? a failure of protective mechanisms
? activation of harmful pathways
? introduction of pathogenic influences
? inappropriate activation of normal mechanisms
? all of the above
Physiologic Response to Heart Failure
Question 4
Physiologic effects of Angiotensin II include:
? vasoconstriction
? activation of thirst
? sodium retention
? aldosterone release
? all of the above
Renin-Angiotensin System
Question 5
The following is a feature of the heart failure state:
? reduced circulating catecholamines
? increased left ventricular end diastolic pressure
? reduced plasma volume
? increased renal sodium excretion
? reduced pulmonary capillary wedge pressure
Compensatory Mechanisms in Heart Failure
* increased preload
* increased sympathetic tone
* increased circulating catecholamines
* increased Renin-angiotensin-aldosterone
* increased vasopressin
* increased atrial natriuretic factor
Question 6
Patients with early heart failure typically present with:
? No symptoms
? Dyspnea on exertion only
? Dyspnea with minimal activity
? Dyspnea at rest
? Acute respiratory distress
Heart Failure
Clinical Manifestations
Symptoms
* dyspnea
* fatigue
* exertional limitation
* weight gain
* poor appetite
* cough
Signs
* tachycardia, tachypnea
* edema
* jugular venous distension
* pulmonary rales
* pleural effusion
* hepato/splenomegaly
* ascites
* cardiomegaly
* S3 gallop
Dyspnea
Clinical Presentations
* exertional shortness of breath
* cough
* orthopnea
* paroxyxmal nocturnal dyspnea
* severe respiratory distress
* respiratory failure
NYHA Functional Classification
* Class I: patients with cardiac disease but no limitation of physical activity
* Class II: ordinary activity causes fatigue, palpitations, dyspnea or anginal pain
* Class III: less than ordinary activity causes fatigue, palpitations, dyspnea or angina
* Class IV:symptoms even at rest
Question 7
Edema in heart failure takes the following form:
? Peripheral edema
? Sacral edema
? Abdominal distention
? anasarca
? Any of the above
Edema
Clinical Presentations
* where - peripheral, sacral, generalized
* objective weight gain
* bloating
* abdominal distension
Question 8
Signs of right heart failure include all the following except:
? Peripheral edema
? Pulmonary rales
? Elevated jugular veins
? hepatomegaly
? Pleural effusions
Left vs Right Heart Failure
Left Heart Failure
* pulmonary congestion
Right Heart Failure
* peripheral edema
* sacral edema
* elevated JVP
* ascites
* hepatomegaly
* splenomegaly
* pleural effusion
Question 9
A diagnosis of heart failure is best extablished on the basis of the following:
? Dyspnea at rest, increased heart size on chest X ray and elevated jugular veins
? Dyspnea with stair climbing, increased heart size on chest X ray and heart rate of 105
? Rest dyspnea, interstitial edema on chest X ray,and elevated jugular veins
? Orthopnea, flow redistribution on chest X Ray, and crackles in lung bases
? PND, bilateral pleural effusions and crackles in lung bases
Criteria for Diagnosis of CHF
HISTORY Points
rest dyspnea4
orthopnea4
PND3
dyspnea walking on level2
dyspnea on climbing1
CHEST X-Ray
alveolar pulmonary edema4
interstitial pulm edema3
bilateral pleural effusion3
CT ratio > 0.503
flow redistribution2
PHYSICALPoints
HR 91-1101
HR > 1102
JVP > 6 cm2
JVP > 6 cm & hepatom3
lung crackles in base1
lung crackles above base2
wheezing3
S33
Question 10
All the following medications can precipitate heart failure in susceptible patient except:
? metoprolol
? spironolactone
? procainamide
? diltiazem
? rosiglitazone
Precipitating Causes of Heart Failure
Question 11
The following investigations should always be carried out in patient presenting with heart failure except:
? Renal function tests
? A ventilation-perfusion scan
? Blood counts
? Electrocardiogram
? Echocardiogram
Investigations for Heart Failure
* EKG
* evidence of ischemia, infarction, LVH, RVH
* rhythm analysis
* Chest X-Ray
* cardiac size
* evidence of pulmonary vascularity
* Blood work
* CBC, renal function, electrolytes
* Assessment of LV Function
Question 12
Patient A.B. presents with clear signs of left heart failure and responds quickly to standard therapy.Follow-up assessment reveals normal LV systolic function.The most likely underlying cause of this patient's heart failure is:
? Diastolic dysfunction
? Mitral valve disruption
? Pulmonary embolism
? Dilated cardiomyopathy
? Ischemic heart disease
Heart Failure with Normal LV systolic function between symptomatic episodes......（后略) ......
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