PAEA EMERGENCY MEDICINE EOR
TOPICS 1/475 QUESTIONS AND
ANSWERS (A+)
what is the most common cause of heart failure?
specifically left sided? right sided? - √Answer :-MC is
CAD (coronary artery disease)
-L sided: *CAD* & HTN
-R sided: *L sided HF* & pulmonary dz
Quiz :decreased ejection fraction, thin ventricular walls,
dilated LV chamber, and an S3 gallop (filling of dilated
ventricle) is associated with systolic or diastolic heart
failure? - √Answer :systolic (MC form of CHF)
*(the sound is actually heard in the diastole though)
-memory trick: "sys-to-lic" 3 consonants = S3
Quiz :normal ejection fraction, thick ventricular walls,
narrowed LV chamber, and an S4 gallop (atrial
contraction into a stiff ventricle) is associated with
systolic or diastolic heart failure? - √Answer :diastolic
-memory trick: "di-a-sto-lic" 4 consonants = S4
Quiz :what are the causes of systolic vs diastolic heart
failure? - √Answer :-systolic: post *MI*, *dilated
cardiomyopathy*, myocarditis
-diastolic: *HTN*, *LVH*, *elderly*, valvular heart dz,
hypertrophic or restrictive cardiomyopathy, constrictive
pericarditis
,Quiz :when the metabolic demands of the body exceed
normal cardiac function (d/t thyrotoxicosis, wet beriberi,
severe anemia, AV shunting, Paget's disease of the
bone) this is termed ________ heart failure -
√Answer :high-output
*fairly uncommon
-low-output HF is just d/t problem w/ myocardial
contraction, ischemia, or chronic HTN
Quiz :what are some causes of acute vs chronic heart
failure? - √Answer :-acute: *largely systolic*;
hypertensive crisis, acute MI, papillary muscle rupture
-chronic: dilated cardiomyopathy (systolic), valvular dz
(diastolic)
Quiz :explain class I-IV New York Heart Association
functional classes - √Answer :-class I: *no sx's*, *no
limitation* during ordinary physical activity
-class II: *mild sx's* (dyspnea or angina), *slight
limitation* during ordinary activity
-class III: *comfortable only at rest* (sx's caused maked
limitation in activity even with minimal exertion
-class IV: *sx's even while at rest*, severe limitations,
inability to carry out physical activity
Quiz :what compensations does the body make when
heart failure (can be due to something that causes
either inc pre/afterload or dec contractility) begins? -
√Answer :1. sympathetic nervous system activation
2. myocyte hypertrophy/remodeling
3. RAAS activation: fluid overload
,Quiz :the following are signs/sx's of what sided heart
failure?
inc pulmonary venous pressure, dyspnea, orthopnea,
rales/rhonchi, chronic non-productive cough with pink
frothy sputum, HTN, Cheyne-Stokes breathing, S3 or
S4, pale skin/cool extremities, sinus tachy, fatigue -
√Answer :L-sided HF
Quiz :the following are signs/sx's of what sided heart
failure?
inc systemic venous pressure, peripheral edema, JVD,
anorexia, N/V, hepatosplenomegaly, RUQ tenderness,
hepatojugular reflex (inc JVP with liver palpation) -
√Answer :R-sided HF
Quiz :-CXR showing Kerley B lines (alternate flow
tracts), cardiomegaly, pleural effusion, pulmonary
edema
-echo with dec EF
-inc BNP on labs
are all signs of? - √Answer :heart failure
*BNP released from atrium with preload too high
(volume overload)
Quiz :what drugs have shown to decrease mortality
rates in pts with heart failure? - √Answer :*ACE
inhibitors* (-prils), ARBs, *beta-blockers* (-lols),
hydralazine + nitrates, spironolactone
, Quiz :in pts who experience the following common side
effects of an ACE inhibitor to treat heart failure, what is
the alternative medication?
-1st dose hypotension, renal insufficiency,
hyperkalemia, cough, angioedema - √Answer :ARBs (-
sartans)
Quiz :what vasodilators are often used to treat heart
failure? - √Answer :hydralazine + nitrates
-good for african americans
-safe in pregnancy
-acts to dec pre/afterload
-used if pt not able to tolerate ACEi/ARBs/BB or if more
control needed
Quiz :what is the most effective treatment for symptoms
of heart failure? - √Answer :diuretics
-loop diuretics (-semides) act on inc excretion of Na, Cl,
K, H2O (so can go hypo on these electrolytes), other
s/e: hyperglycemia, hyperuricemia
-K-sparing diuretics (spironolactone, eplerenone)
aldosterone antagonists; s/e: hyperkalemia,
gynecomastia with spirono
-HCTZ or metolazone (thiazide like diuretic)- s/e:
hyponatremia/kalemia, hyperuricemia, hyperglycemia
Quiz :what medications are used to treat acute severe
heart failure? - √Answer :*sympathomimetics* (positive
inotropes to inc contractility)
-*digoxin*: but has a narrow therapeutic index (can
cause arrhythmias, seizures, dizziness, GI upset, visual
disturbances, gynecomastia); toxicity = downsloping ST
segment; antidote: Digoxin Immune Fab