CEA Prep: Cardiac
What is the key long-term benefit of using carvedilol for patients with coronary artery
disease and heart failure with reduced ejection fraction (HFrEF)? - CORRECT
ANSWER-Potential increase in ejection fraction
Rationale: EF increase is a key reason for using carvedilol over metoprolol for patients
with low EF states. Libido unfortunately can be negatively impacted by any beta blocker.
Cardiac output should only improve with long term use, not decrease, and beta blockers
may reduce blood pressure slightly, but that is not their key long-term benefit. In fact,
they are not even considered for routine anti-hypertensive management per JNC-8
guidelines.
An example of secondary prevention for a diagnosis of coronary artery disease includes
which of the following? - CORRECT ANSWER-Coronary artery bypass grafting
Rationale: CABG represents the only guaranteed evidence of fixing patients who
already have coronary artery disease. The rest remain as primary prevention strategies.
Effective long-term treatment of systolic heart failure with reduced ejection fraction
should include which of the following? - CORRECT ANSWER-Prescribing
valsartan/sacubitril (Entresto) unless contraindicated on discharge
Rationale: Angiotensin Receptor and Neprilysin Inhibition is considered goal-directed
therapy for patients with reduced systolic heart function as evidence by the PARAGON-
HF Trial. Auscultation is an assessment item, not a treatment. Midazolam does not have
any long term benefit for heart failure. Fluid bolus in a patient with likely fluid overload
from systolic heart failure only worsen their presenting symptoms.
Which of the following end-organ sequelae is not directly caused by uncontrolled
hypertension? - CORRECT ANSWER-Peripheral neuropathy
Rationale: Although patients with hypertension frequently have peripheral neuropathy, it
is only directly attributed to patients who are also diabetic and is commonly found in
non-hypertensive diabetic patients. Proteinuria, AV nicking, and hemorrhagic stroke are
all caused by uncontrolled hypertension.
A 70-year-old man with a history of atrial fibrillation presents with sudden-onset left-
sided weakness and slurred speech. What is the most likely diagnosis? - CORRECT
ANSWER-Stroke
Rationale: The patient with a history of atrial fibrillation for over 48 hours without
anticoagulation is at risk of an embolic stroke, secondary to mobilization of a thrombus
(90% of which occur in the left atrial appendage). A patient exhibiting signs of a stroke
such as unilateral weakness and slurred speech, in addition to being evaluated for
What is the key long-term benefit of using carvedilol for patients with coronary artery
disease and heart failure with reduced ejection fraction (HFrEF)? - CORRECT
ANSWER-Potential increase in ejection fraction
Rationale: EF increase is a key reason for using carvedilol over metoprolol for patients
with low EF states. Libido unfortunately can be negatively impacted by any beta blocker.
Cardiac output should only improve with long term use, not decrease, and beta blockers
may reduce blood pressure slightly, but that is not their key long-term benefit. In fact,
they are not even considered for routine anti-hypertensive management per JNC-8
guidelines.
An example of secondary prevention for a diagnosis of coronary artery disease includes
which of the following? - CORRECT ANSWER-Coronary artery bypass grafting
Rationale: CABG represents the only guaranteed evidence of fixing patients who
already have coronary artery disease. The rest remain as primary prevention strategies.
Effective long-term treatment of systolic heart failure with reduced ejection fraction
should include which of the following? - CORRECT ANSWER-Prescribing
valsartan/sacubitril (Entresto) unless contraindicated on discharge
Rationale: Angiotensin Receptor and Neprilysin Inhibition is considered goal-directed
therapy for patients with reduced systolic heart function as evidence by the PARAGON-
HF Trial. Auscultation is an assessment item, not a treatment. Midazolam does not have
any long term benefit for heart failure. Fluid bolus in a patient with likely fluid overload
from systolic heart failure only worsen their presenting symptoms.
Which of the following end-organ sequelae is not directly caused by uncontrolled
hypertension? - CORRECT ANSWER-Peripheral neuropathy
Rationale: Although patients with hypertension frequently have peripheral neuropathy, it
is only directly attributed to patients who are also diabetic and is commonly found in
non-hypertensive diabetic patients. Proteinuria, AV nicking, and hemorrhagic stroke are
all caused by uncontrolled hypertension.
A 70-year-old man with a history of atrial fibrillation presents with sudden-onset left-
sided weakness and slurred speech. What is the most likely diagnosis? - CORRECT
ANSWER-Stroke
Rationale: The patient with a history of atrial fibrillation for over 48 hours without
anticoagulation is at risk of an embolic stroke, secondary to mobilization of a thrombus
(90% of which occur in the left atrial appendage). A patient exhibiting signs of a stroke
such as unilateral weakness and slurred speech, in addition to being evaluated for
