PAEA Outpatient/Family Medicine EOR Topics
what is the most common cause of heart failure? specifically left sided? right sided? - correct
answer -MC is CAD (coronary artery disease)
-L sided: *CAD* & HTN
-R sided: *L sided HF* & pulmonary dz
decreased ejection fraction, thin ventricular walls, dilated LV chamber, and an S3 gallop (filling
of dilated ventricle) is associated with systolic or diastolic heart failure? - correct answer
systolic (MC form of CHF)
*(the sound is actually heard in the diastole though)
-memory trick: "sys-to-lic" 3 consonants = S3
normal ejection fraction, thick ventricular walls, narrowed LV chamber, and an S4 gallop (atrial
contraction into a stiff ventricle) is associated with systolic or diastolic heart failure? - correct
answer diastolic
-memory trick: "di-a-sto-lic" 4 consonants = S4
what are the causes of systolic vs diastolic heart failure? - correct answer -systolic: post *MI*,
*dilated cardiomyopathy*, myocarditis
-diastolic: *HTN*, *LVH*, *elderly*, valvular heart dz, hypertrophic or restrictive
cardiomyopathy, constrictive pericarditis
when the metabolic demands of the body exceed normal cardiac function (d/t thyrotoxicosis,
wet beriberi, severe anemia, AV shunting, Paget's disease of the bone) this is termed ________
heart failure - correct answer high-output
*fairly uncommon
-low-output HF is just d/t problem w/ myocardial contraction, ischemia, or chronic HTN
what are some causes of acute vs chronic heart failure? - correct answer -acute: *largely
systolic*; hypertensive crisis, acute MI, papillary muscle rupture
-chronic: dilated cardiomyopathy (systolic), valvular dz (diastolic)
explain class I-IV New York Heart Association functional classes - correct answer -class I: *no
sx's*, *no limitation* during ordinary physical activity
-class II: *mild sx's* (dyspnea or angina), *slight limitation* during ordinary activity
,PAEA Outpatient/Family Medicine EOR Topics
-class III: *comfortable only at rest* (sx's caused maked limitation in activity even with minimal
exertion
-class IV: *sx's even while at rest*, severe limitations, inability to carry out physical activity
what compensations does the body make when heart failure (can be due to something that
causes either inc pre/afterload or dec contractility) begins? - correct answer 1. sympathetic
nervous system activation
2. myocyte hypertrophy/remodeling
3. RAAS activation: fluid overload
the following are signs/sx's of what sided heart failure?
inc pulmonary venous pressure, dyspnea, orthopnea, rales/rhonchi, chronic non-productive
cough with pink frothy sputum, HTN, Cheyne-Stokes breathing, S3 or S4, pale skin/cool
extremities, sinus tachy, fatigue - correct answer L-sided HF
the following are signs/sx's of what sided heart failure?
inc systemic venous pressure, peripheral edema, JVD, anorexia, N/V, hepatosplenomegaly, RUQ
tenderness, hepatojugular reflex (inc JVP with liver palpation) - correct answer R-sided HF
-CXR showing Kerley B lines (alternate flow tracts), cardiomegaly, pleural effusion, pulmonary
edema
-echo with dec EF
-inc BNP on labs
are all signs of? - correct answer heart failure
*BNP released from atrium with preload too high (volume overload)
what drugs have shown to decrease mortality rates in pts with heart failure? - correct answer
*ACE inhibitors* (-prils), ARBs, *beta-blockers* (-lols), hydralazine + nitrates, spironolactone
in pts who experience the following common side effects of an ACE inhibitor to treat heart
failure, what is the alternative medication?
-1st dose hypotension, renal insufficiency, hyperkalemia, cough, angioedema - correct answer
ARBs (-sartans)
what vasodilators are often used to treat heart failure? - correct answer hydralazine + nitrates
,PAEA Outpatient/Family Medicine EOR Topics
-good for african americans
-safe in pregnancy
-acts to dec pre/afterload
-used if pt not able to tolerate ACEi/ARBs/BB or if more control needed
what is the most effective treatment for symptoms of heart failure? - correct answer diuretics
-loop diuretics (-semides) act on inc excretion of Na, Cl, K, H2O (so can go hypo on these
electrolytes), other s/e: hyperglycemia, hyperuricemia
-K-sparing diuretics (spironolactone, eplerenone) aldosterone antagonists; s/e: hyperkalemia,
gynecomastia with spirono
-HCTZ or metolazone (thiazide like diuretic)- s/e: hyponatremia/kalemia, hyperuricemia,
hyperglycemia
what medications are used to treat acute severe heart failure? - correct answer
*sympathomimetics* (positive inotropes to inc contractility)
-*digoxin*: but has a narrow therapeutic index (can cause arrhythmias, seizures, dizziness, GI
upset, visual disturbances, gynecomastia); toxicity = downsloping ST segment; antidote: Digoxin
Immune Fab
-*dobutamine*: inc contractility (B1 agonist), peripheral vasodilation
-*dopamine*: inc contractility
giving a synthetic BNP, Nesiritide, works by what mechanism to treat heart failure? - correct
answer -dec RAAS activity
-inc Na+/H2O excretion
why are beta-blockers started after ACE inhibitors/diuretics in heart failure? - correct answer
want to decrease afterload/preload before slowing down the heart rate
at what EF do heart failure patients need to receive an implantable cardioverter defibrillator? -
correct answer EF <35% because they tolerate arrhythmias poorly and there is inc mortality
rate
what medication used to treat *systolic* heart failure is a selective sinus node inhibitor that
slows the sinus rate? - correct answer *ivabradine*: dec mortality rate in pts w/ EF ≤35%, in
sinus rhythm, w/ resting pulse ≥70bpm, & already maxed out on BB dose or unable to take BB
what medication used to treat *systolic* heart failure works by increasing levels of natriuretic
peptides? - correct answer *sacubitril-valsartan*: decreases mortality rate in class II-IV HF w/
reduced EF
, PAEA Outpatient/Family Medicine EOR Topics
what is the treatment for acute pulmonary edema/congestive (aka decompensated) heart
failure? - correct answer *LMNOP*
-*L*asix: removes fluids- improves sx's
-*M*orphine: reduces preload reducing heart strain
-*N*itrates: vasodilator to reduce pre/afterload
-*O*xygen
-*P*osition: upright to dec venous return
if severe may also need inotropic support
hypertension is defined as ____/____ blood pressures on ____ or more visits - correct answer
≥130/80 on 2 or more visits
-stage 1 is 130-139/80-89
-stage 2 is ≥140/90
although primary HTN makes up 95% of cases, when should secondary HTN be considered?
what are some causes of secondary HTN? - correct answer -if refractory to antihypertensives or
severely elevated
-causes: *renal artery stenosis*, fibromuscular dysplasia, atherosclerosis, 1°
hyperaldosteronism, pheochromocytoma, cushing's syndrome, coarctation of the aorta, sleep
apnea, EtOH, OCPs, COX-2 inhibitors
what are the complications of HTN? - correct answer -CV (CAD, HF, MI, LVH, aortic dissection,
aortic aneurysm, PVD)
-neurologic (TIA, CVA, rutured aneurysms, encephalopathy)
-nephropathy (renal stenosis & sclerosis leading to ESRD)
-optic (retinal hemorrhage, blindness, retinopathy)
thiazide type diuretics (HCTZ, chlorthalidone, metolazone) act on what part of the nephron to
increase water excretion? what are the side effects? - correct answer -distal diluting tubule
-s/e: hyponatremia/kalemia/calcemia, hyperuricemia/glycemia (use w/ caution in gout and DM
pts)
what is the most common cause of heart failure? specifically left sided? right sided? - correct
answer -MC is CAD (coronary artery disease)
-L sided: *CAD* & HTN
-R sided: *L sided HF* & pulmonary dz
decreased ejection fraction, thin ventricular walls, dilated LV chamber, and an S3 gallop (filling
of dilated ventricle) is associated with systolic or diastolic heart failure? - correct answer
systolic (MC form of CHF)
*(the sound is actually heard in the diastole though)
-memory trick: "sys-to-lic" 3 consonants = S3
normal ejection fraction, thick ventricular walls, narrowed LV chamber, and an S4 gallop (atrial
contraction into a stiff ventricle) is associated with systolic or diastolic heart failure? - correct
answer diastolic
-memory trick: "di-a-sto-lic" 4 consonants = S4
what are the causes of systolic vs diastolic heart failure? - correct answer -systolic: post *MI*,
*dilated cardiomyopathy*, myocarditis
-diastolic: *HTN*, *LVH*, *elderly*, valvular heart dz, hypertrophic or restrictive
cardiomyopathy, constrictive pericarditis
when the metabolic demands of the body exceed normal cardiac function (d/t thyrotoxicosis,
wet beriberi, severe anemia, AV shunting, Paget's disease of the bone) this is termed ________
heart failure - correct answer high-output
*fairly uncommon
-low-output HF is just d/t problem w/ myocardial contraction, ischemia, or chronic HTN
what are some causes of acute vs chronic heart failure? - correct answer -acute: *largely
systolic*; hypertensive crisis, acute MI, papillary muscle rupture
-chronic: dilated cardiomyopathy (systolic), valvular dz (diastolic)
explain class I-IV New York Heart Association functional classes - correct answer -class I: *no
sx's*, *no limitation* during ordinary physical activity
-class II: *mild sx's* (dyspnea or angina), *slight limitation* during ordinary activity
,PAEA Outpatient/Family Medicine EOR Topics
-class III: *comfortable only at rest* (sx's caused maked limitation in activity even with minimal
exertion
-class IV: *sx's even while at rest*, severe limitations, inability to carry out physical activity
what compensations does the body make when heart failure (can be due to something that
causes either inc pre/afterload or dec contractility) begins? - correct answer 1. sympathetic
nervous system activation
2. myocyte hypertrophy/remodeling
3. RAAS activation: fluid overload
the following are signs/sx's of what sided heart failure?
inc pulmonary venous pressure, dyspnea, orthopnea, rales/rhonchi, chronic non-productive
cough with pink frothy sputum, HTN, Cheyne-Stokes breathing, S3 or S4, pale skin/cool
extremities, sinus tachy, fatigue - correct answer L-sided HF
the following are signs/sx's of what sided heart failure?
inc systemic venous pressure, peripheral edema, JVD, anorexia, N/V, hepatosplenomegaly, RUQ
tenderness, hepatojugular reflex (inc JVP with liver palpation) - correct answer R-sided HF
-CXR showing Kerley B lines (alternate flow tracts), cardiomegaly, pleural effusion, pulmonary
edema
-echo with dec EF
-inc BNP on labs
are all signs of? - correct answer heart failure
*BNP released from atrium with preload too high (volume overload)
what drugs have shown to decrease mortality rates in pts with heart failure? - correct answer
*ACE inhibitors* (-prils), ARBs, *beta-blockers* (-lols), hydralazine + nitrates, spironolactone
in pts who experience the following common side effects of an ACE inhibitor to treat heart
failure, what is the alternative medication?
-1st dose hypotension, renal insufficiency, hyperkalemia, cough, angioedema - correct answer
ARBs (-sartans)
what vasodilators are often used to treat heart failure? - correct answer hydralazine + nitrates
,PAEA Outpatient/Family Medicine EOR Topics
-good for african americans
-safe in pregnancy
-acts to dec pre/afterload
-used if pt not able to tolerate ACEi/ARBs/BB or if more control needed
what is the most effective treatment for symptoms of heart failure? - correct answer diuretics
-loop diuretics (-semides) act on inc excretion of Na, Cl, K, H2O (so can go hypo on these
electrolytes), other s/e: hyperglycemia, hyperuricemia
-K-sparing diuretics (spironolactone, eplerenone) aldosterone antagonists; s/e: hyperkalemia,
gynecomastia with spirono
-HCTZ or metolazone (thiazide like diuretic)- s/e: hyponatremia/kalemia, hyperuricemia,
hyperglycemia
what medications are used to treat acute severe heart failure? - correct answer
*sympathomimetics* (positive inotropes to inc contractility)
-*digoxin*: but has a narrow therapeutic index (can cause arrhythmias, seizures, dizziness, GI
upset, visual disturbances, gynecomastia); toxicity = downsloping ST segment; antidote: Digoxin
Immune Fab
-*dobutamine*: inc contractility (B1 agonist), peripheral vasodilation
-*dopamine*: inc contractility
giving a synthetic BNP, Nesiritide, works by what mechanism to treat heart failure? - correct
answer -dec RAAS activity
-inc Na+/H2O excretion
why are beta-blockers started after ACE inhibitors/diuretics in heart failure? - correct answer
want to decrease afterload/preload before slowing down the heart rate
at what EF do heart failure patients need to receive an implantable cardioverter defibrillator? -
correct answer EF <35% because they tolerate arrhythmias poorly and there is inc mortality
rate
what medication used to treat *systolic* heart failure is a selective sinus node inhibitor that
slows the sinus rate? - correct answer *ivabradine*: dec mortality rate in pts w/ EF ≤35%, in
sinus rhythm, w/ resting pulse ≥70bpm, & already maxed out on BB dose or unable to take BB
what medication used to treat *systolic* heart failure works by increasing levels of natriuretic
peptides? - correct answer *sacubitril-valsartan*: decreases mortality rate in class II-IV HF w/
reduced EF
, PAEA Outpatient/Family Medicine EOR Topics
what is the treatment for acute pulmonary edema/congestive (aka decompensated) heart
failure? - correct answer *LMNOP*
-*L*asix: removes fluids- improves sx's
-*M*orphine: reduces preload reducing heart strain
-*N*itrates: vasodilator to reduce pre/afterload
-*O*xygen
-*P*osition: upright to dec venous return
if severe may also need inotropic support
hypertension is defined as ____/____ blood pressures on ____ or more visits - correct answer
≥130/80 on 2 or more visits
-stage 1 is 130-139/80-89
-stage 2 is ≥140/90
although primary HTN makes up 95% of cases, when should secondary HTN be considered?
what are some causes of secondary HTN? - correct answer -if refractory to antihypertensives or
severely elevated
-causes: *renal artery stenosis*, fibromuscular dysplasia, atherosclerosis, 1°
hyperaldosteronism, pheochromocytoma, cushing's syndrome, coarctation of the aorta, sleep
apnea, EtOH, OCPs, COX-2 inhibitors
what are the complications of HTN? - correct answer -CV (CAD, HF, MI, LVH, aortic dissection,
aortic aneurysm, PVD)
-neurologic (TIA, CVA, rutured aneurysms, encephalopathy)
-nephropathy (renal stenosis & sclerosis leading to ESRD)
-optic (retinal hemorrhage, blindness, retinopathy)
thiazide type diuretics (HCTZ, chlorthalidone, metolazone) act on what part of the nephron to
increase water excretion? what are the side effects? - correct answer -distal diluting tubule
-s/e: hyponatremia/kalemia/calcemia, hyperuricemia/glycemia (use w/ caution in gout and DM
pts)
