Heart failure occurs when the heart fails to pump blood at the necessary rate. It may be caused by myocardial failure but also may occur in the presence of near-normal cardiac function under conditions of high demand. According to the American Heart Association, heart failure affects nearly 5.7 million Americans of all ages and accounts for 34% of all cardiovascular-related deaths. Do you know what to watch for and how best to approach heart failure? Test your knowledge with this short quiz.
Which of the following is NOT recognized as a common underlying cause of systolic heart failure?
Diabetes mellitus
Peripartum cardiomyopathy
Supraventricular arrhythmia
Neurofibromatosis type 1
Specific underlying factors cause various forms of heart failure, such as systolic heart failure (most commonly, left ventricular [LV] systolic dysfunction), heart failure with preserved left ventricular ejection fraction (LVEF), acute heart failure, high-output heart failure, and right heart failure.
Underlying causes of systolic heart failure include the following:
·Coronary artery disease
·Diabetes mellitus
·Hypertension
·Valvular heart disease (stenosis or regurgitant lesions)
·Arrhythmia (supraventricular or ventricular)
·Infections and inflammation (myocarditis)
·Peripartum cardiomyopathy
·Congenital heart disease
·Drugs (either recreational, such as alcohol and cocaine, or therapeutic drugs with cardiac side effects, such as doxorubicin)
For more on the etiology of heart failure, read here.
Which of the following American College of Cardiology (ACC) and American Heart Association (AHA) stages do the majority of patients with heart failure fall under?
Stage A
Stage B
Stage C
Stage D
Most patients with heart failure are in stage C. ACC/AHA stage C patients have structural heart disease and current or previous symptoms of heart failure; ACC/AHA stage C corresponds with New York Heart Association (NYHA) class II and III heart failure.
Drugs routinely used in these patients include ACE inhibitors/angiotensin receptor blockers, beta-blockers, and loop diuretics for fluid retention. For selected patients, therapeutic measures include aldosterone receptor blockers, hydralazine and nitrates in combination, and cardiac resynchronization with or without an implanted cardiac device.
For more on the staging of heart failure, read here.
Which of the following studies is not usually required in the routine diagnosis and management of heart failure?
Cardiac CT scanning
ECG
Chest radiography
Echocardiography
A screening ECG is reasonable in patients with symptoms suggestive of heart failure. Chest radiographs are used in cases of heart failure to assess heart size, pulmonary congestion, pulmonary or thoracic causes of dyspnea, and the proper positioning of any implanted cardioverter-defibrillators (ICDs). Two-dimensional echocardiography is recommended in the initial evaluation of patients with known or suspected heart failure. CT scanning or MRI may be useful in evaluating chamber size and ventricular mass, cardiac function, and wall motion; delineating congenital and valvular abnormalities; and demonstrating the presence of pericardial disease. However, cardiac CT scanning is usually not required in the routine diagnosis and management of heart failure, and echocardiography and MRI may provide similar information without exposing the patient to ionizing radiation.
For more on the workup of heart failure, read here.
Which of the following should be avoided in patients with heart failure?
Diuretics
Digoxin
Anticoagulants
Calcium channel blockers
The ACC/AHA guidelines advise that nonsteroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers, and most antiarrhythmic agents may exacerbate heart failure and should be avoided in most patients. NSAIDs can cause sodium retention and peripheral vasoconstriction and can attenuate the efficacy and enhance the toxicity of diuretics and ACE inhibitors.
For more about the treatment of heart failure, read here.
In which of the following categories of patients do AHA/ACC guidelines indicate ICDs?
Patients with symptomatic documented hemodynamically unstable ventricular tachycardia with an LVEF < 40%
Patients who have no history of prior rhythm problems with an LVEF of 40%
Patients who are asymptomatic (NYHA class I) with an LVEF of 35%
Patients who are newly diagnosed with an LVEF of 35% 10 days post-MI
The AHA/ACC recommend ICD placement for the following categories of heart failure patients:
·Patients with LV dysfunction (LVEF ≤ 35%) from a previous MI who are at least 40 days post-Ml
·Patients with nonischemic cardiomyopathy; with an LVEF ≤ 35%; in NYHA class II or III; receiving optimal medical therapy; and expected to survive longer than 1 year with good functional status
·Patients with ischemic cardiomyopathy who are at least 40 days post-MI; have an LVEF of ≤ 30%; are in NYHA functional class I; are on chronic optimal medical therapy; and are expected to survive longer than 1 year with good functional status
·Patients who have had ventricular fibrillation
·Patients with documented hemodynamically unstable ventricular tachycardia (VT) and/or VT with syncope; with an LVEF < 40%; on optimal medical therapy; and expected to survive longer than 1 year with good functional status
For more on the treatment of heart failure, read here.
