Question 1

Stage C patients usually require a combination of three to four drugs to manage their heart failure.In addition to ACE inhibitors and beta blockers,diuretics may be added.Which of the following statements about diuretics is NOT true?

Accepted Answer

Potassium-sparing diuretics should be used cautiously with ARBs due to the risk of hyperkalemia, not as a standard practice.

Question 2

Treatments for heart failure,including drug therapy,are based on the stages developed by the ACC/AHA.Stage A patients are treated with:

Accepted Answer

Stage A patients are not yet showing symptoms of heart failure but are at high risk for developing it due to underlying conditions such as hypertension and hyperlipidemia. Therefore, the focus is on managing these conditions with drugs to prevent the development of heart failure. Lifestyle management is also important but is not the only treatment option. ACE inhibitors are typically used in later stages when symptoms are present. No drugs are not used in any stage of heart failure management.

Question 3

Digoxin has a very limited role in treatment of heart failure.It is used mainly for patients with:

Accepted Answer

Digoxin is primarily used to control symptoms in patients with heart failure who have an audible S3 on physical examination. It has not been shown to improve mortality or reduce hospitalizations in heart failure patients. Its use is not based on ejection fraction, primary cause of heart failure, or renal function.

Question 4

One of the three types of heart failure involves systolic dysfunction.Potential causes of this most common form of heart failure include:

Accepted Answer

Myocardial ischemia and injury secondary to myocardial infarction can lead to systolic dysfunction, which is the most common form of heart failure.

Question 5

Class I recommendations for Stage A heart failure include:

Accepted Answer

The answer of Class I recommendations for Stage A heart...

Question 6

ACE inhibitors are a central part of the treatment of heart failure because they have more than one action to address the pathological changes in this disorder.Which of the following pathological changes in heart failure is NOT addressed by ACE inhibitors?

Accepted Answer

The answer of ACE inhibitors are a central part of...

Question 7

ACE inhibitors are contraindicated in pregnancy.While treatment of heart failure during pregnancy is best done by a specialist,which of the following drug classes are considered to be safe,at least in the later parts of pregnancy?

Accepted Answer

While all drug classes have potential risks during pregnancy, beta blockers have been studied extensively and are generally considered safe to use in later parts of pregnancy for the treatment of heart failure. Diuretics and nitrates may also be used with caution, but ARBs are contraindicated in pregnancy. It is important to note that treatment during pregnancy should only be done under the guidance of a specialist.

Question 8

The American Heart Association and the American College of Cardiology have devised a classification system for heart failure that can be used to direct treatment.Patients with symptoms and underlying disease are classified as:

Accepted Answer

Patients with symptoms and underlying disease are classified as Stage C. Stage C is defined as structural heart disease with prior or current symptoms of heart failure. This stage requires aggressive management such as medical therapy and cardiac devices. Stages A and B refer to patients who have not developed symptoms or have asymptomatic structural heart disease. Stage D refers to end-stage heart failure with advanced symptoms despite treatment.

Question 9

Diagnosis of heart failure cannot be made by symptoms alone since many disorders share the same symptoms.The most specific and sensitive diagnostic test for heart failure is:

Accepted Answer

Two-dimensional echocardiograms are the most specific and sensitive diagnostic test for heart failure as they can identify structural anomalies and cardiac dysfunction. Chest x-rays may show cephalization and heart size but may not be specific enough to confirm heart failure. Complete blood count, BUN, and serum electrolytes may help to stage end-organ damage but may not provide a clear diagnosis of heart failure. Measurement of brain natriuretic peptide levels can help to distinguish between systolic and diastolic dysfunction, but it is not as specific as an echocardiogram for diagnosing heart failure.

Question 10

Increased life expectancy for patients with heart failure has been associated with the use of:

Accepted Answer

ACE inhibitors have been shown to decrease morbidity and mortality in patients with heart failure, especially when started early in the disease process. Beta blockers and diuretics may be beneficial for symptom management, but they do not have the same mortality benefit as ACE inhibitors. Cardiac glycosides, such as digoxin, may improve symptoms but have not been shown to increase life expectancy.

Question 11

Heart failure is a chronic condition that can be adequately managed in primary care.However,consultation with or referral to a cardiologist is appropriate when:

Accepted Answer

All of the listed conditions could indicate a need for consultation with or referral to a cardiologist. Markedly worsening symptoms or hypotension with syncope could be indicative of decompensated heart failure, which may require more specialized interventions. Progressive renal insufficiency can also complicate management of heart failure, and a cardiologist may be needed to adjust medication regimens to prevent further damage to the kidneys. If a patient remains symptomatic on optimal doses of medication, a cardiologist may be needed to explore additional treatment options.

Question 12

Heart failure is a leading cause of death and hospitalization in older adults (greater than 65 years old).The drug of choice for this population is:

Accepted Answer

ACE inhibitors have been shown to reduce mortality and hospitalizations in older adults with heart failure. They work by blocking the action of angiotensin II, a hormone that can cause narrowing of blood vessels and increase in blood pressure, which can lead to heart failure worsening. Aldosterone antagonists and eplerenone are also recommended as add-on therapy for patients with heart failure, but they are not considered the first-line treatment choices. ARBs can be used as an alternative to ACE inhibitors, but they are not the drug of choice.

Question 13

Which of the following classes of drugs is contraindicated in heart failure?

Accepted Answer

Calcium channel blockers, including long-acting dihydropyridines, are contraindicated in heart failure due to their negative ionotropic effects, which can worsen already compromised cardiac function. Nitrates, on the other hand, can be beneficial in heart failure by reducing preload and afterload. Alpha-beta blockers are also sometimes used in heart failure treatment.

Question 14

Stage B patients should have beta blockers added to their heart failure treatment regimen when:

Accepted Answer

Both options A and B are indications for the addition of beta blockers in Stage B heart failure patients according to current guidelines. Beta blockers have been shown to improve survival and reduce hospitalizations in this patient population.

Quiz 36: Heart Failure