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AHFN Review
| Question | Answer |
|---|---|
| Decreased cardiac output would cause the following neurohormonal response to occur: - Activation of the SNS - Activation of PNS - Inactivation of the RAAS -Suppression of cytokine release | Activation of the SNS |
| Which statement is false regarding HFpEF? A. Impairment of left ventricular relaxation B. Increased left ventricular wall stiffness; reduced compliance C. Impaired diastolic ventricular filling D. Not as common as HFrEF | Not as common as HFrEF |
| Which of the following describes systolic dysfunction of HFrEF: a. impaired relaxation of LV with reduced LV filling b. thick ventricular walls, normal LV cavity size, EF 50% c. EF 60% with clear lungs d. thin walled, dilated left ventricular, EF 35% | thin walled, dilated left ventricular, EF 35% |
| HFpEF is best defined as: a. HF in which diastole is shortened b. impaired ability of the LV to relax and fill c. HF with an elevated diastolic blood pressure d. impaired ability of the left ventricle to contract and effectively eject blood | impaired ability of the LV to relax and fill |
| A patient who has previously had HFrED (EF<40%) and now has an EF of 46% is said to have: a. HFpEF B. HFpEF, borderline C. HFimpEF, improved D. a normal EF | HFimpEF, improved |
| With neurohormonal activation, you would expect to see all of the following except: a)Elevated catecholamine release b)Increased concentrations of renin, angiotensin II, and aldosterone c) Decreased myocardial oxygen demand d) Release of vasopressin | Decreased myocardial oxygen demand |
| Which of the following is involved in the neurohormonal imbalance that occurs in HF? a) Reduced vascular impedance or resistance b) Increased sodium and water retention c) Reduced B-type natriuretic peptide (BNP) level d) Decreased heart rate | Increased sodium and water retention |
| Which would exclude your patient from receiving a hTx: - Living w/ her sister after divorcing her husband - PHTN despite max therapy to lower pulm pressure - DM that is controlled by diet - Creat 1.4 mg/dL following diuresis in the hospital | PHTN despite max therapy to lower pulm pressure |
| Requirements to receive a bridge to transplant left ventricular assist device include: - A reliable social support system in place - A commitment to participate in self-care - Eligibility for transplant - All of the above | All of the above |
| A patient who has previously had HFrEF (EF<40%) and now has an EF of 46% is said to have: - HFpEF - HFpEF, borderline - HFimpEF, improved - A normal EF | HFimpEF, improved |
| Educating patients about heart failure is determined by the: - Education level of the nurse taking care of the patient - Availability of patient education videos - Culture, values and learning modes as determined by the patient - All of the above | All of the above |
| Many patients have a low level of healthcare literacy. One to help improve the outcomes of education in patients with low healthcare literacy is: - Hypnosis - Formal education classes - Teach back - Written materials at the 12th grade level | Teach back |
| Another term used for cardiac resynchronization therapy is: - Biventricular pacing - Anti-tachycardia pacing - Dual chamber pacing - Bradycardia backup pacing | Biventricular pacing |
| Indications for CRT include all except: - HF with EF ≤35% - Intraventricular conduction delay with QRS duration ≥150 msec - HF that is symptomatic in spite of optimal GDMT - Recurrent a. fib that has failed 2 attempts at cardioversion | Recurrent a. fib that has failed 2 attempts at cardioversion |
| When administering spironolactone or eplerenone, which of the following is true: - risk for hyperkalemia - risk for thrombocytopenia - risk for increased bleeding - risk for hypervolemia | The patient is at risk for hyperkalemia |
| Drugs used to block the renin-angiotensin-aldosterone system (RAAS) either directly or indirectly in HF include all of the following except: - Ace inhibitors - Calcium channel blockers - Beta blockers - Angiotensin receptor blockers (ARB) | Calcium channel blockers |
| Which of the following is a contraindication to using an ACE-I? - Coronary artery disease - Renal insufficiency - Baseline hypotension - Bilateral renal artery stenosis | Bilateral renal artery stenosis |
| Which HF medication has a potential side effect of a lupus reaction? - Nitrates - ACE-I - Beta Blockers - Hydralazine | Hydralazine |
| Which type of diuretic is the first line choice for managing heart failure? - Loop diuretics - Thiazides - Potassium sparing diuretics - Combination of loop & thiazide | Loop diuretics |
| All of the following are reported side effects from loop diuretics except: - Hypokalemia - Dizziness - Visual disturbances described as halos - Gout | Visual disturbances described as halos |
| Which of the following are the beta blockers proven to reduce mortality in HF patients? - Atenolol, carvedilol, entresto - Bisoprolol, atenolol, metoprolol, - Bisoprolol, Carvedilol, metoprolol sustained release - Bisoprolol, Lisinopril, carvedilol | Bisoprolol, Carvedilol, metoprolol sustained release |
| Which of the following symptoms of hypoglycemia is not masked by beta blockers? - Lightheadedness - Diaphoresis - Weakness - Fatigue | Diaphoresis |
| True or False: HF stages can change? | False: HF classes can change, but stages can not change. (Stages Stay) |
| Cardiac Output (CO) normal range: | 4-8 L/min |
| Cardiac Index (CI) normal range: | 2.5-4.0 |
| Right Atrial Pressure (RAP) normal range: | 2-6 mmHg |
| Pulmonary Atrial Wedge Pressure (PAWP) normal range: | 6-12 mmHg |
| List the 4 Pillars of GDMT: | AcEi/ ARNi Beta- Blockers MRA SGLT2 Inhibitors |
| PQRST: | P- Provocation Q- Quality R- Region or radiation S- Severity, signs, & symptoms T- Time of onset, duration, or intensity |
| Is HFpEF or HFrEF more prevalent? | Both- 50/50 |
| Cardiomegaly will displace the PMI in which direction? | Downward and laterally |
| Are systolic or diastolic murmurs pathologic? | Diastolic (systolic murmurs are typically innocent while diastolic always has a reason) |
| Between S3 and S4 murmurs, which one is ventricular and which is atrial? | S3 murmurs are ventricular S4 murmurs are atrial |
| A 6MW resulting in < 300m is a predictor of what? | Increased mortality |
| VO2 max < 14mL/kg/min indicates: | poor prognosis and determines candidacy for HTx. |
| When transitioning a patient from ACE to ARNi (or vice versa) requires a washout of how many hours? | 36 hours |
| Which of the following is a contraindication for starting a patient on Entresto? - Creat. 1.2 - HFrEF diagnosis - Renal Artery Stenosis - All the above | Renal Artery Stenosis |
| List the approved BB for HF patients | Metoprolol Succinate Carvedilol Bisoprolol |
| True or False: First line of therapy for a patient with CI of 1.4, CVP of 9, and PAWP of 20 would be initiation of a BB | False Must wait to initiate a BB until decongested/ dry or could go into cardiogenic shock. (if patient was already prescribed a BB, dose should be down titrated until dry. If patient is in active cardiogenic shock, BB must be stopped!) |
| Which of the following hypoglycemia symptoms may still be present in a patient taking beta blockers? A. Tachycardia B. Tremors C. Confusion D. Palpitations | Confusion |
| True or False: HFrEF patients can be titrated off GDMT medications once EF% has improved? | False: HFrEF patients should remain on GDMT for life! |
| Which statement is true regarding patients with LVAD? -They will never have a palpable pulse -Presence of a pulse always indicates device failure -A palpable pulse may be present if myocardial function improves -BP cannot be measured in these patients | A palpable pulse may be present if myocardial function improves |
| Which of the following best describes the 5-year mortality rate for patients diagnosed with heart failure? A. 10% B. 25% C. 50% D. 75% | C. 50% |
| What is the approximate 1-year mortality rate for patients hospitalized with advanced heart failure (AHF)? A. 5–10% B. 15–20% C. 30–50% D. Greater than 70% | C. 30-50% |
| What is the gold standard treatment for end stage heart failure? | Heart Transplant |
| A pt w/ chronic HF presents to the ED with acute decompensated HF & volume overload. He takes furosemide 40 mg PO QD. What is the recommended initial dose? A. 40 mg IV B. 20 mg IV C. At least 80 mg IV D. Hold diuretics until BNP results return | C. At least 80 mg IV |
| True or False: Heart failure patients who are educated to appropriately self-adjust their diuretics based on weight and symptoms tend to have better outcomes compared to those without a self-management plan | True |
| A 64 yo pt with HFrEF on max tolerated GDMT has an EF 30%. ECG shows NSR w/ LBBB & QRS duration of 162 ms. NYHA Class II symptoms persist. What is the next best therapy? A. Increase beta blocker dose only B. ICD C. CRT-D D. No further intervention | CRT-D |
| ICM pt w/EF 28% despite GDMT. He has never sustained VT or had cardiac arrest. He is eval for ICD. Intervention would be: A. Secondary prevention B. Primary prevention C. Treatment of symptomatic bradycardia D. Cardiac resynchronization therapy | B. Primary prevention |
| True or False: Heart Failure Class IV patients DO NOT get ICD placement due to life expectancy <1 year. | True |
Created by:
katallen