Deck 38: Heart Failure

Question 1

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

A)Myocardial ischemia and injury secondary to myocardial infarction (MI)
B)Inadequate relaxation and loss of muscle fiber secondary to valvular dysfunction
C)Increased demands of the heart beyond its ability to adapt secondary to anemia
D)Slower filling rate and elevated systolic pressures secondary to uncontrolled hypertension

Answer 1

Myocardial ischemia and injury secondary to myocardial infarction (MI)

Question 2

Angiotensin-converting-enzyme (ACE) inhibitors are a central part of the treatment of heart failure (HF) because they have more than one action to address the pathological changes in this disorder. Which of the following pathological changes that take place in HF is NOT addressed by ACE inhibitors?

A)Changes in the structure of the left ventricle so that it dilates, hypertrophies, and uses energy less efficiently
B)Reduced formation of cross-bridges so that contractile force decreases
C)Activation of the sympathetic nervous system that increases heart rate and preload
D)Decreased renal blood flow that decreases oxygen supply to the kidneys

Answer 2

Activation of the sympathetic nervous system that increases heart rate and preload

Question 3

Which of the following classes of drugs is contraindicated in HF?

A)Nitrates
B)Long-acting dihydropyridines
C)Calcium channel blockers
D)Alpha-beta blockers

Answer 3

Calcium channel blockers

Question 4

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

A)Weight
B)Blood pressure (BP)
C)Heart rate
D)Serum glucose

Question 5

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

A)Aldosterone antagonists
B)Eplerenone
C)ACE inhibitors
D)ARBs

Question 6

Class I recommendations for stage A HF include:

A)Aerobic exercise within tolerance levels to prevent the development of HF
B)Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention
C)Beta blockers for all patients regardless of cardiac history
D)Treatment of thyroid disorders, especially if they are associated with tachyarrhythmias

Question 7

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

A)Drugs for hypertension and hyperlipidemia, if they exist
B)Lifestyle management including diet, exercise, and smoking cessation only
C)ACE inhibitors to directly prevent the HF only
D)No drugs are used in this early stage

Question 8

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

A)When the patient enters stage III
B)Only in cases of diastolic failure
C)When there is concurrent AFib
D)In all cases

Question 9

Stage B patients should have nonselective beta blockers added to their HF treatment regimen when:

A)They have an ejection fraction less than 40%
B)They have had a recent MI
C)Both 1 and 2
D)Neither 1 nor 2

Question 10

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

A)They have no role.
B)They can give very precise pictures of pulmonary fluid status.
C)They provide an idea of general cardiac size and pulmonary great vessel distribution.
D)They can confirm the diagnosis.

Question 11

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

A)Ejection fractions above 40%
B)An audible S3
C)Mitral stenosis as a primary cause for HF
D)Renal insufficiency

Question 12

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

A)A
B)B
C)C
D)D

Question 13

Evidence is strong that HF interventions are best initiated when:

A)The person enters stage C
B)The person has functional disabilities
C)At the earliest indication
D)Stage IV is determined

Question 14

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

A)Diuretics reduce preload associated with fluid retention.
B)Diuretics can be used earlier than stage C when the goal is hypertension control.
C)Diuretics may produce problems with electrolyte imbalances, abnormal glucose, and lipid metabolism.
D)Diuretics from the potassium-sparing class should be used when using an angiotensin receptor blocker (ARB).

Question 15

In the later part of the 20^th century, increased life expectancy for patients with HF has been associated with the use of:

A)ACE inhibitors, especially when started early in the disease process
B)All beta blockers regardless of selectivity
C)Thiazide and loop diuretics
D)Cardiac glycosides

Question 16

ACE inhibitors are contraindicated in pregnancy. While treatment of HF 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?

A)Diuretics
B)ARBs
C)Beta blockers
D)Nitrates

Question 17

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

A) Elderly patients with reduced renal clearance
B) Pregnant women
C) Women under age 30
D) 1 and 2

Question 18

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

A)Symptoms markedly worsen or the patient becomes hypotensive and has syncope.
B)There is evidence of progressive renal insufficiency or failure.
C)The patient remains symptomatic on optimal doses of an ACE inhibitor, a beta blocker, and a diuretic.
D)Any of the above

Question 19

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

A)Chest x-rays that show cephalization and measure heart size
B)Two-dimensional echocardiograms that identify structural anomalies and cardiac dysfunction
C)Complete blood count, blood urea nitrogen, and serum electrolytes that facilitate staging for end-organ damage
D)Measurement of brain natriuretic peptide to distinguish between systolic and diastolic dysfunction

Question 20

Changing a diuretic to the aldosterone agonist class is frequently beneficial to HF patients except in the following circumstance:

A)When they are advancing to a later stage of failure
B)When they have moderate to severe symptoms
C)When they have persistent hyperkalemia
D)Prior to the advance of renal dysfunction

Question 21

The sensitivity of the myocardium to low potassium levels when a patient takes Digoxin can be off set by changing the treatment plan if the patient has frequent drops in potassium levels on their loop diuretic. What is the change that should be made?

A)Increase the dose of the loop diuretic
B)Add potassium supplements
C)Use a combination of thiazide and loop diuretic
D)Decrease the digoxin dose

Question 22

Digoxin is used as the classic medication to demonstrate loading dose methods to get a patient to therapeutic doses of a medication. When should a loading dose approach NOT be used for this medication?

A)When the patient is frail and elderly
B)When the HF symptoms are rapidly accelerating
C)When the renal status is stable
D)When the patient has never been on digoxin before

Question 23

Once the fluid overload of a HF flare is corrected, what is the proper role of diuretics?

A)They should only to be used intermittently when fluid becomes an issue.
B)To maintain a baseline level of therapy
C)Only the aldosterone agonist class should be used.
D)The dosing should be increased aggressively to ensure maintenance of a dry weight status.

Question 24

Eplerenone, an aldosterone antagonist medication, differs from the classic aldosterone medication because it doesn't create the following troublesome side effect:

A)Gynecomastia
B)Retention of potassium
C)Promotion of myocardial fibrosis
D)Relaxation of the cardiac sphincter