Question 1 Ten year survival after the onset of heart failure:,80-90% 60-79% 40-59% 20-39% Under 20%,Prognosis in Heart Failure Men over 45 years of Age,Surviving (%),Years from Diagnosis,Prognosis in Heart Failure Women over 45 years of Age,Surviving (%),Years from Diagnosis,Question 2 Potential underlying causes of heart failure include:,Coronary artery disease Hemochromatosis Mitral regurgitation Ventricular septal defect all of the above,Heart Failure The Final Common Pathway,ischemic disease valvular disease cardiomyopathy pericardial disease hypertension congenital,Heart Failure,Question 3 The pathophysiology of heart failure can best be described as:,a failure of protective mechanisms activation of harmful pathways introduction of pathogenic influences inappropriate activation of normal mechanisms all of the above,Physiologic Response to Heart Failure,LV Dysfunction,Renal-Adrenal,Carotid and LABaroreceptors,Renin- Angiotensin,Aldosterone,Sympathetic Output,Sodium and fluid retention,tachycardia,vasoconstriction,Question 4 Physiologic effects of Angiotensin II include:,vasoconstriction activation of thirst sodium retention aldosterone release all of the above,Renin-Angiotensin System,Renin,Angiotensin I,Angiotensin II,decreased renal perfusion,decreased Na delivery,sympatheticactivity,AVP Release,vasoconstriction,aldosterone,Increased thirst,NE release,sodium retention,decreased GFR,Question 5 The following is a feature of the heart failure state:,reduced circulating catecholamines increased left ventricular end diastolic pressure reduced plasma volume increased renal sodium excretion reduced pulmonary capillary wedge pressure,Compensatory Mechanisms in Heart Failure,increased preload increased sympathetic tone increased circulating catecholamines increased Renin-angiotensin-aldosterone increased vasopressin increased atrial natriuretic factor,Question 6 Patients with early heart failure typically present with:,No symptoms Dyspnea on exertion only Dyspnea with minimal activity Dyspnea at rest Acute respiratory distress,Heart Failure Clinical Manifestations,Symptoms dyspnea fatigue exertional limitation weight gain poor appetite cough,Signs tachycardia, tachypnea edema jugular venous distension pulmonary rales pleural effusion hepato/splenomegaly ascites cardiomegaly S3 gallop,Dyspnea Clinical Presentations,exertional shortness of breath cough orthopnea paroxyxmal nocturnal dyspnea severe respiratory distress respiratory failure,NYHA Functional Classification,Class I: patients with cardiac disease but no limitation of physical activityClass II: ordinary activity causes fatigue, palpitations, dyspnea or anginal painClass III: less than ordinary activity causes fatigue, palpitations, dyspnea or angina Class IV: symptoms even at rest,Question 7 Edema in heart failure takes the following form:,Peripheral edema Sacral edema Abdominal distention anasarca Any of the above,Edema Clinical Presentations,where - peripheral, sacral, generalized objective weight gain bloating abdominal distension,Question 8 Signs of right heart failure include all the following except:,Peripheral edema Pulmonary rales Elevated jugular veins hepatomegaly Pleural effusions,Left vs Right Heart Failure,Left Heart Failure pulmonary congestion,Right Heart Failure peripheral edema sacral edema elevated JVP ascites hepatomegaly splenomegaly pleural effusion,Question 9 A diagnosis of heart failure is best extablished on the basis of the following:,Dyspnea at rest, increased heart size on chest X ray and elevated jugular veins Dyspnea with stair climbing, increased heart size on chest X ray and heart rate of 105 Rest dyspnea, interstitial edema on chest X ray, and elevated jugular veins Orthopnea, flow redistribution on chest X Ray, and crackles in lung bases PND, bilateral pleural effusions and crackles in lung bases,Criteria for Diagnosis of CHF,HISTORY Pointsrest dyspnea 4orthopnea 4PND 3dyspnea walking on level 2dyspnea on climbing 1CHEST X-Rayalveolar pulmonary edema 4interstitial pulm edema 3bilateral pleural effusion 3CT ratio 0.50 3flow redistribution 2,PHYSICAL PointsHR 91-110 1HR 110 2JVP 6 cm 2JVP 6 cm & hepatom 3lung crackles in base 1lung crackles above base 2wheezing 3S3 3,8-12 points - definite CHF 5-7 points - possible CHF 5 points - unlikely CHF,Question 10 All the following medications can precipitate heart failure in susceptible patient except:,metoprolol spironolactone procainamide diltiazem rosiglitazone,Precipitating Causes of Heart Failure,1. ischemia,2. change in diet, drugs or both,3. increased emotional or physical stress,4. cardiac arrhythmias (eg. atrial fib),5. infection,6. concurrent illness,7. uncontrolled hypertension,8. New high output state (anemia, thyroid),9. pulmonary embolism,10. Mechanical disruption (sudden MR, VSD, AR),Question 11 The following investigations should always be carried out in patient presenting with heart failure except:,