Question 1

HF patients frequently take more than one drug. When are anticoagulants typically used?

Accepted Answer

Anticoagulants are typically used in cases of concurrent A Fib, as A Fib increases the risk of blood clots and stroke. They may not be used in all cases of HF patients taking multiple drugs.

Question 2

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 is considered to be safe, at least in the later parts of pregnancy?

Accepted Answer

Beta blockers have been shown to be effective and safe for use in the later parts of pregnancy in the treatment of heart failure. Diuretics and nitrates may also be safe for use, but may require close monitoring. ARBs are not recommended during pregnancy as they can cause harm to the fetus. However, it is important to consult a specialist for individualized treatment recommendations.

Question 3

Angiotensin-converting-enzyme (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

C

Question 4

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 those who are at high risk for heart failure but do not have any structural abnormalities or symptoms of heart failure. These patients are typically treated with drugs for hypertension and hyperlipidemia, if they exist, as well as lifestyle modifications such as diet, exercise, and smoking cessation to reduce their risk of developing heart failure. ACE inhibitors are not typically used in this stage as they are reserved for patients with symptomatic heart failure or structural abnormalities.

Question 5

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 6

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 7

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

Accepted Answer

ACE inhibitors have been shown to improve survival and quality of life in patients with heart failure. The earlier they are initiated in the disease process, the greater the benefit. Beta blockers and diuretics are also commonly used in the management of heart failure, but ACE inhibitors have been specifically associated with increased life expectancy. Cardiac glycosides (such as digoxin) may improve symptoms but have not been consistently shown to improve survival in heart failure patients.

Question 8

Evidence is strong that the timing of HF interventions are best initiated when:

Accepted Answer

Evidence suggests that HF interventions are most effective when initiated at the earliest indication, which includes symptoms such as dyspnea and fatigue, and signs such as elevated jugular venous pressure and edema. Waiting until a person reaches stage C or D may result in irreversible damage and/or hospitalization, whereas early intervention can improve outcomes and quality of life for those with HF. Therefore, it is crucial to recognize early signs and symptoms and initiate appropriate interventions promptly.

Question 9

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

Accepted Answer

Calcium channel blockers, especially non-dihydropyridines (like verapamil and diltiazem), are generally contraindicated in heart failure due to their negative inotropic effects, which can worsen heart failure symptoms. Long-acting dihydropyridines are generally safer in heart failure due to their vasodilatory effects, but caution is advised.

Question 10

Class I recommendations for stage A heart failure include:

Accepted Answer

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

Question 11

Diagnosis of heart failure cannot be made by symptoms alone because 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 because they can identify structural anomalies and cardiac dysfunction. Chest x-rays, blood tests, and brain natriuretic peptide measurements can help support the diagnosis but are not as specific or sensitive as an echocardiogram.

Question 12

ACE inhibitors are a foundational medication in HF. Which group of patients cannot take them safely?

Accepted Answer

Elderly patients with reduced renal clearance and pregnant women cannot safely take ACE inhibitors. ACE inhibitors can cause harm to the fetus and can also worsen kidney function in patients with reduced renal clearance. Therefore, options A and B are the correct choices, and option C is irrelevant as there is no age restriction for ACE inhibitor use in women.

Question 13

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 stage:

Accepted Answer

The American Heart Association and the American College of Cardiology classification system for heart failure includes four stages: A, B, C, and D. Stage C refers to patients who have symptoms of heart failure and underlying structural heart disease. This stage is further divided into two categories, C1 and C2, which indicate whether the patient has or has not been previously hospitalized for heart failure. Treatment for stage C heart failure typically includes medications such as diuretics, ACE inhibitors, and beta-blockers, as well as lifestyle modifications such as sodium restriction and exercise.

Question 14

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 improve survival and reduce hospitalizations in older adults with heart failure. Aldosterone antagonists and eplerenone may be added on in certain cases but are not the initial drug of choice. ARBs have not been shown to be as effective as ACE inhibitors in heart failure management.

Question 15

What assessment that can be done at home is the most reliable for making decisions to change HF medications?

Accepted Answer

Monitoring weight is the most reliable home assessment for making decisions to change heart failure (HF) medications. Sudden weight gain can indicate fluid retention, a common issue in HF, necessitating medication adjustment.

Question 16

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

Diuretics from the potassium-sparing class can lead to an increased risk of hyperkalemia when used with an angiotensin receptor blocker (ARB), as both can increase potassium levels. This combination should be used with caution, not as a general recommendation.

Question 17

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

Each of the scenarios listed in A, B, and C warrant consultation with or referral to a cardiologist as they indicate a need for further evaluation and management beyond what can be provided in primary care.

Question 18

What can chest x-rays contribute to the diagnosis and management of HF?

Accepted Answer

Chest X-rays can provide an idea of general cardiac size and pulmonary great vessel distribution, which can be useful in the diagnosis and management of HF. However, they cannot give very precise pictures of pulmonary fluid status and cannot confirm the diagnosis on their own.

Question 19

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

Accepted Answer

Stage B patients with a reduced ejection fraction (less than 40%) should be treated with beta blockers to improve their heart function and reduce the risk of heart failure progression. Beta blockers have also been shown to be beneficial in preventing further myocardial infarctions. Therefore, both 1 and 2 are correct.

Quiz 36: Heart Failure