ABFM HEART DISEASE EXAM QUESTIONS WITH CORRECT ANSWERS A 65-year-old female who has heart failure with an ejection fraction of 35% is found to have a TSH level of 13.8 µU/mL (N 0.3-4.82). Her T3 and T4 levels are normal, and her thyroid gland is normal to

ABFM HEART DISEASE EXAM QUESTIONS WITH CORRECT ANSWERS A 65-year-old female who has heart failure with an ejection fraction of 35% is found to have a TSH level of 13.8 µU/mL (N 0.3-4.82). Her T3 and T4 levels are normal, and her thyroid gland is normal to palpation. You check her levels again in 2 months and they are unchanged. You advise her that hypothyroidism decreases her metabolic rate, which reduces the stress on her heart hypothyroidism is detrimental to her heart only if she develops hypothyroid symptoms subclinical hypothyroidism has negative effects on heart failure and treatment should be considered treatment of subclinical hypothyroidism would raise her LDL-cholesterol level - Correct Answer C Clinical hypothyroidism has long been associated with cardiac dysfunction. It has also been shown that subclinical hypothyroidism (TSH >4 µU/mL with normal or borderline low thyroid hormone levels) can cause left ventricular systolic and diastolic dysfunction, which improves with thyroid replacement therapy. Patients with overt or subclinical hypothyroidism should be treated with levothyroxine to improve their cardiovascular function and decrease the potential risk of heart failure. Thyroxine in excess can exacerbate coronary artery disease, and should be started at low doses and increased slowly in patients with possible underlying coronary artery disease. Results of meta-analyses indicate that therapy will lower, not raise, serum LDL-cholesterol levels. A 58-year-old male is hospitalized with severe decompensated heart failure refractory to intravenous inotropic therapy and guideline-directed medical therapy. You are considering referral to a tertiary care hospital for mechanical circulatory support to bridge to transplantation.Which one of the following is true regarding mechanical circulatory support bridge therapy? It should be limited to patients who meet the criteria for heart transplantation It should only be used in patients with biventricular heart failure It generally improves quality of life while waiting for transplantation It greatly reduces quality of life while waiting for transplantation - Correct Answer c Mechanical circulatory support (MCS) with a ventricular assist device has continued to evolve and has emerged as a viable therapeutic option for patients with advanced stage D heart failure with reduced ejection fraction refractory to guideline-directed medical therapy and cardiac device intervention. A variety of ventricular assist devices are now available. These devices may be either intracorporeal or extracorporeal, and may be designed to assist the left ventricle, right ventricle, or both.Bridge therapy refers to the use of left ventricular assist devices to help a patient survive until a donor heart becomes available for transplantation. Several devices are available, some of which are implantable and allow patients to be discharged to their homes. These devices can increase patient activity levels and quality of life. Complications can occur, including stroke, infection, and death, but these devices can be lifesaving in patients with refractory heart failure.The data from the Interagency Registry for Mechanically Assisted Circulatory Support indicates that cardiogenic shock, advanced age, and severe right heart failure (manifested as ascites or increased bilirubin) are major risk factors for death after MCS. This led to a recommendation that referral for MCS be considered before severe right ventricular failure develops. Possible indications for a bridge-to-candidacy ventricular assist device include obesity, tobacco use, and severe pulmonary hypertension in patients who might otherwise be candidates for transplantation. A 65-year-old female who has heart failure with an ejection fraction of 35% is found to have a TSH level of 13.8 µU/mL (N 0.3-4.82). Her T3 and T4 levels are normal, and her thyroid gland is normal to palpation. You check her levels again in 2 months and they are unchanged. You advise her that hypothyroidism decreases her metabolic rate, which reduces the stress on her heart hypothyroidism is detrimental to her heart only if she develops hypothyroid symptoms subclinical hypothyroidism has negative effects on heart failure and treatment should be considered treatment of subclinical hypothyroidism would raise her LDL-cholesterol level - Correct Answer C Clinical hypothyroidism has long been associated with cardiac dysfunction. It has also been shown that subclinical hypothyroidism (TSH >4 µU/mL with normal or borderline low thyroid hormone levels) can cause left ventricular systolic and diastolic dysfunction, which improves with thyroid replacement therapy. Patients with overt or subclinical hypothyroidism should be treated with levothyroxine to improve their cardiovascular function and decrease the potential risk of heart failure. Thyroxine in excess can exacerbate coronary artery disease, and should be started at low doses and increased slowly in patients with possible underlying coronary artery disease. Results of meta-analyses indicate that therapy will lower, not raise, serum LDL-cholesterol levels. A 58-year-old male is hospitalized with severe decompensated heart failure refractory to intravenous inotropic therapy and guideline-directed medical therapy. You are considering referral to a tertiary care hospital for mechanical circulatory support to bridge to transplantation.Which one of the following is true regarding mechanical circulatory support bridge therapy? It should be limited to patients who meet the criteria for heart transplantation It should only be used in patients with biventricular heart failure It generally improves quality of life while waiting for transplantation It greatly reduces quality of life while waiting for transplantation - Correct Answer c Mechanical circulatory support (MCS) with a ventricular assist device has continued to evolve and has emerged as a viable therapeutic option for patients with advanced stage D heart failure with reduced ejection fraction refractory to guideline-directed medical therapy and cardiac device intervention. A variety of ventricular assist devices are now available. These devices may be either intracorporeal or extracorporeal, and may be designed to assist the left ventricle, right ventricle, or both.Bridge therapy refers to the use of left ventricular assist devices to help a patient survive until a donor heart becomes available for transplantation. Several devices are available, some of which are implantable and allow patients to be discharged to their homes. These devices can increase patient activity levels and quality of life. Complications can occur, including stroke, infection, and death, but these devices can be lifesaving in patients with refractory heart failure.The data from the Interagency Registry for Mechanically Assisted Circulatory Support indicates that cardiogenic shock, advanced age, and severe right heart failure (manifested as ascites or increased bilirubin) are major risk factors for death after MCS. This led to a recommendation that referral for MCS be considered before severe right ventricular failure develops. Possible indications for a bridge-to-candidacy ventricular assist device include obesity, tobacco use, and severe pulmonary hypertension in patients who might otherwise be candidates for transplantation.