what is the most common etiology of heart failure?
a. drug-induced
b. idiopathic
c. viral cardiomyopathy
d. hypertension
e.
... [Show More] ischemic
ischemic
what is the medical term for the symptom of "feels short of breath when lying down at night"
a. orthopnea
b. hepatojugular reflux
c. pulmonary congestion
d. paroxysmal nocturnal dyspnea
e. peripheral edema
orthopnea
which of the following is TRUE regarding ACEis in heart failure?
a. efficacy of ACEis is a class effect
b. should be discontinued if creatinine clearance decreases by more than 10%
c. should be used mainly in severe heart failure, NYHA functional class IV
d. can be replaced by ARBs if the patient has hypertension
e. may be used in place of hydrazine and isosorbide denigrate in cases of renal dysfunction
efficacy of ACEis is a class effect
which of the following is true regarding B-blockers in heart failure?
a. chronic B-blockade increases ventricular mass
b. metoprolol tartrate is more efficacious than carvedilol for heart failure
c. metoprolol has more potent BP lowering effects compared to carvedilol
d. ideally should be started in setting of congestion to aid in diuresis
e. FDA approved agents include carvedilol and metoprolol succinate
FDA approved agents include carvedilol and metoprolol succinate
A 74-year-old woman presents to clinic for heart failure follow-up. She is classified as NYHA FC II. Her blood pressure is 144/82 mm Hg, and most recent EF is 26% (0.26).
Her current medication regimen includes lisinopril 20 mg QD, carvedilol 25 mg BID, digoxin 0.125 mg QD, and furosemide 20 mg BID. Which of the following would be the BEST choice to add at this time?
a. valsartan
b. metolazone
c. hydrochlorothiazide
d. hydralazine and isosorbide
e. spironolactone
spironolactone
Mineralocorticoid receptor antagonists (or aldosterone receptor antagonists) have been shown to reduce mortality in patients with heart failure. Which of the following is TRUE about MRAs?
a. can only be used in NYHA functional class IV
b. added to loop diuretic when a patient is resistant to its effects to enhance removal of fluids
c. used after maximizing ACEis, B-blockers, and digoxin
d. associated with hypokalemia
e. spironolactone leads more frequently to gynecomastia compared to eplerenone
spironolactone leads more frequently to gynecomastia compared to eplerenone
A 76-year-old man is admitted to the hospital presenting with peripheral and pulmonary edema, decreased urinary output, hypotension, and altered mental status. Pertinent values:
PCWP = 32 mm Hg (4.3 kPa), Cardiac index (CI) = 1.8 L/min/m2. Based on his presentation, what hemodynamic subset is he in?
a. I
b. II
c. III
d. IV
e. II and IV
IV
A 68-year-old African American woman is admitted to the hospital for new onset acute decompensated heart failure. Her current medications include felodipine 2.5 mg QD and atorvastatin 20 mg QD. Hemodynamic readings include a PCWP of 16 (2.1 kPa) and a CI of 1.8 L/min/m2. Which of the following is the MOST appropriate treatment plan?
a. diuretics, fluids, inotropes
b. fluids, inotropes
c. fluids, inotropes, vasodilators
d. diuretics, vasodilators
e. diuretics, inotropes, vasodilators
fluids, inotropes
Which of the following statements is most appropriate for patient counseling on non-pharmacologic management of heart failure?
a. weight should be kept at 15% above ideal body weight to maintain adequate nutrition
b. lower dietary sodium intake to no more than 2g per day
c. contact health care provider if weight increases by more than 3lbs in a day or 5lbs in a week
d. maintain alcohol intake to no more than 2 drinks per day if diagnosed with alcohol-induced heart-failure
e. supervised exercise is recommended including aerobic activity and weight lifting
contact health care provider if weight increases by more than 3lbs in a day or 5lbs in a week
A 68-year-old woman is admitted for decompensated heart failure, hemodynamic subset IV. Her current medication regimen includes enalapril 10 mg BID, digoxin 0.125 mg QD, carvedilol 12.5 mg BID, furosemide 80 mg BID, and potassium chloride (K-Dur) 40 mEq (40 mmol) BID. Which of the following is TRUE regarding using milrinone therapy in this patient?
a. milrinone can interact with her B-blocker therapy due to its B-agonist mechanism
b. effects begin to wear off after 72 hours due to tolerance
c. dose needs to be adjusted in renal dysfunction
d. milrinone is not appropriate to use in subset IV
e. both A and C
dose needs to be adjusted in renal dysfunction
All of these are drugs that will slow AV conduction to protect the ventricles in atrial fibrillation EXCEPT:
a. B-blockers
b. atropine
c. nondihydrotide CCB
d. digoxin
e. all of the above
atropine
A 23-year-old female who has a history of supraventricular tachycardia is having an acute episode again. She has attempted a valsalva maneuver without success in breaking the arrhythmia. The ECG confirms SVT. What is the next step in therapy for this patient?
a. acebutolol
b. atropine
c. amiodarone
d. amiodipine
e. adenosine
adenosine
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Which of the following drug class(es) may be used for ventricular rate control in the treatment of atrial fibrillation (AF)?
a. B-blockers
b. CCB
c. cardiac glycoside
d. amiodarone
e. all of the above
all of the above
Which one of the following arrhythmias increases the risk of stroke two- to sevenfold?
a. A Fib
b. paroxysmal supraventricular tachycardia
c. ventricular tachycardia
d. ventricular premature depolarization
A Fibe
Characteristics associated with the drug amiodarone include:
a. its electrophysiological effects include some properties common to agents in Vaughn-Williams classes I, II, III, and IV
b. it has extensive tissue distribution to adipose tissue and highly perfused organs
c. some EP effects of the drug may be seen within hours after a parenteral dose, but its effects on.... days or a week or more
d. it contains a relatively large amount of iodide which is released during its metabolism and may have adverse effects
e. all of the above
all of the above
A 65-year-old man has a past medical history of hypertension and coronary artery disease, for which he is currently receiving hydrochlorothiazide 25 mg daily, enalapril 10 mg twice daily, and amlodipine 10 mg daily. He presents to his physician complaining of intermittent palpitations and light-headedness. An ambulatory ECG reveals 6 to 10 ventricular premature depolarizations per hour, intermittent couplets, and a heart rate of 82 beats/min. Which one of the following is the most appropriate course of action?
a. Amiodarone 400 mg daily
b. Flecanide 150 mg q 12 hours
c. metoprolol 50 mg BID
d. no treatment should be initiated
metoprolol 50 mg BID
A 65-year-old man was admitted to the cardiac intensive care unit today with an exacerbation of heart failure due to a hypertensive crisis. Echocardiogram reveals a left ventricular ejection fraction of 35% [0.35]. He also has a past history of hypertension and dyslipidemia. While in the cardiac intensive care unit, the patient complains of palpitations and light-headedness, and his blood pressure is 105/70 mm Hg. ECG reveals ventricular tachycardia at a rate of 125 beats/min, which lasts longer than 30 seconds and does not terminate on its own. Which one of the following is the most appropriate treatment?
a. IV pocainamide
b. IV verapamil
c. no treatment necessary
d. immediate direct current ardioversion
e. IV amiodarone
IV amiodarone
Each of the following is recommended monitoring for patients requiring chronic amiodarone therapy except
a. CXR
b. thyroid function tests
c. LFTs
d. coagulation tests
e. electrocardiogram
coagulation tests
Which of the following medications would be preferred for control of ventricular response inpatients with atrial fibrillation and heart failure?
a. verapamil
b. digoxin
c. diltiazem
d. dofelitide
digoxin
A 66-year-old male with a past medical history of congestive heart failure and hypertension is receiving lisinopril 10 mg po qd, digoxin 0.25 mg po qd, carvedilol 25 mg bid, and spironolactone 25 mg po qd at home. He now presents to the emergency room with a 1-week history of intermittent palpitations and dizziness. The EGG reveals atrial fibrillation with a ventricular rate of 130 bpm. The decision is made to attempt to restore normal sinus rhythm. Which of the following represents the best therapeutic approach to cardioverting the patient?
a. anticoagulation for 2 weeks prior to cardioversion; continue anticoagulation for at least 4 weeks postcardioversion
b. perform TEE; if no thrombus is present, cardiovert; there is no need for anticoagulation
c. Perform TEE; if no thrombus is present, cardiovert; anticoagulant for at least 4 weeks postcardioversion
d. anticoagulate for 4 weeks prior to cardioversion; discontinue anticoagulation postcardioversion
e. direct current cardiovert immediately
perform TEE; if no thrombus is present, cardiovert; anticoagulant for at least 4 weeks post cardioversion
Implementing a treatment plan that includes a vasodilator such as Hydralazine requires monitoring the patient for:
a. Postural hypotension
b. Reflex tachycardia
c. Headache
d. Drug-induced lupus
e. All of the above
all of the above
Use the MOA of ACEi to determine the physiologic action that results in treatment of CHF:
a. ACE inhibitors reduce the formation of angiotensin II
b. ACE Inhibitors promote the excretion of Na and H2O from kidneys
c. ACE inhibitors decrease the inactivation of bradykinin
d. All of these are correct
all of these are correct
Select the preferred Beta-blocker used for the treatment of CHF:
a. Ramipril (Altace) and Lisinopril (Zestril)
b. Metoprolol Succinate (Toprol XL) and Carvedilol (Coreg)
c. Atenolol and Metoprolol
d. None of these are correct
metoprolol succinate (Toprol XL) and carvedilol (Coreg)
A 74 y/o female presents to the office for HF follow up. She is diagnosed as NYHA FC III. Her BP reads 144/82 mmHg and EF 26%. She takes: Lisinopril, Digoxin, and Furosemide. What else should you add?
a. Metolazone (Thiazide)
b. Hydralazine and isosorbide (Vasodilator)
c. Spironolactone (Aldosterone Antagonist)
d. Metoprolol (Beta Blocker)
e. Valsartan (Angiotensin Receptor Blocker)
metoprolol (Beta Blocker)
Treatment with which of the following drug classes has/have been shown to improve the survival of patients treatment for heart failure?
a. Cardiac glycosides such as Digoxin
b. Beta adrenergic blockers such as Metoprolol
c. Combination of Hydralazine and Isosorbide Dinitrate
d. Only B and C
e. All of the Above
only B and C
Drug termed "inodilator":
a. Dopamine (Inotropes)
b. Milrinone (Inotrope) - Good for pts already on B-Blockers
c. Amiodarone (K+ Channel Blocker)
d. Ranolazine (Anti-Ischemic - usually added to B-Blockers or Nitrates)
e. Epinephrine (Vasoconstrictor)
Milrinone (Inotrope) - Good for pt already on B-blockers
Potential adverse effects associated with loop diuretics in treatment of CHF may include:
a. Over diuresis leading to hypotension, fatigue, and renal impairment
b. Hyperkalemia
c. Hypermagnesemia
d. All of the above
e. None of the above
over diuresis leading to hypotension, fatigue, and renal impairment [Show Less]