Question 1

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 asymptomatic, but have risk factors for heart failure such as hypertension and hyperlipidemia. Therefore, treating these risk factors with medications is important to prevent the development of heart failure. Lifestyle management is also recommended, but drug therapy may be necessary in addition to lifestyle changes. ACE inhibitors are not used in Stage A unless the patient has a specific indication for their use.

Question 2

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 3

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

Accepted Answer

ACE inhibitors have been shown to improve outcomes in patients with heart failure, especially when started early in the disease process. They are recommended as first-line therapy for all patients with heart failure and reduced ejection fraction. Beta blockers are also recommended for use in most patients with heart failure, but not all beta blockers have been shown to improve outcomes. Thiazide and loop diuretics are used for symptom control but do not have a significant impact on life expectancy. Cardiac glycosides are no longer recommended for routine use in patients with heart failure.

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

Systolic dysfunction is characterized by an impaired ability of the heart to contract and pump blood effectively. Myocardial ischemia and injury can lead to a weakening of the heart muscle, resulting in decreased cardiac output and heart failure.

Question 5

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 three options (A, B, and C) indicate a need for consultation with or referral to a cardiologist for further management of heart failure. If symptoms markedly worsen, if there is evidence of progressive renal insufficiency or failure, or if the patient remains symptomatic despite receiving optimal doses of medications, further evaluation and management by a specialist may be necessary.

Question 6

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 7

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

Accepted Answer

Digoxin has a limited role in heart failure treatment and is mainly used for patients with an audible S3. This is because digoxin slows down the heart rate, which can reduce the intensity of the S3 sound and improve symptoms in these patients. It is not typically used for patients with ejection fractions above 40%, mitral stenosis as a primary cause for heart failure, or renal insufficiency.

Question 8

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 safe for use in pregnant women with heart failure, particularly in the later stages of pregnancy. Diuretics may be used cautiously but can lead to complications such as electrolyte imbalances and decreased blood volume. ARBs are contraindicated in pregnancy and nitrates have not been extensively studied for use in pregnant women. It is important to note that any treatment for heart failure during pregnancy should be managed by a specialist.

Question 9

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 may show some signs of heart failure, but they are not as specific or sensitive as echocardiograms. Blood tests may reveal end-organ damage, but they do not provide a definitive diagnosis of heart failure. Brain natriuretic peptide can help distinguish between systolic and diastolic dysfunction, but it is not the most specific or sensitive diagnostic test for heart failure.

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

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

Accepted Answer

Stage B patients with an ejection fraction less than 40% and those who have had a recent MI should have beta blockers added to their heart failure treatment regimen. Beta blockers have been shown to improve survival and reduce symptoms in patients with heart failure.

Question 12

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

Accepted Answer

Early intervention is key in managing heart failure and improving outcomes. Waiting until a person enters a specific stage or has functional disabilities may result in missed opportunities to prevent disease progression and improve quality of life. Therefore, interventions should be initiated at the earliest indication of heart failure, such as when symptoms first appear or when risk factors are identified. Waiting until stage IV may be too late and lead to significant symptom burden and worse outcomes.

Question 13

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 14

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 helpful in diagnosing HF and determining management strategies. They cannot give very precise pictures of pulmonary fluid status and cannot confirm the diagnosis on their own.

Question 15

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

Accepted Answer

Anticoagulants are typically used when there is concurrent A Fib in HF patients to prevent the risk of blood clots and reduce risk of stroke. They may not be used in all cases as the choice of medication depends on the specific condition and medical history of the patient.

Question 16

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 17

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

Accepted Answer

ACE inhibitors are contraindicated in patients with reduced renal clearance, which is common in the elderly population. They are also contraindicated in pregnant women as they can cause harm to the fetus. Therefore, options A and B are correct. Option C is incorrect as it is arbitrary and not relevant to ACE inhibitor contraindications.

Question 18

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

The answer of Angiotensin-converting-enzyme (ACE) inhibitors are a central part...

Question 19

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 hospitalization in older adults with heart failure. They help to block the action of angiotensin II, a hormone that can contribute to heart failure, and improve overall cardiovascular function. Aldosterone antagonists such as eplerenone and ARBs may also be used in certain cases, but ACE inhibitors are generally considered the drug of choice in this population.

Quiz 36: Heart Failure