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Knowledge Check: Pathophysiology of Heart Failure

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Question 1 of 10

1. Question

Which of the following is a sign of “increased preload” in a 10 year old boy with heart failure?

High urinary output from too much volume circulating in his body

High blood pressure from too much volume circulating in his body

Pulmonary edema from backup of fluid into the lungs

Muffled heart sounds from too much fluid around the heart

Hint

Hint: Chapter 1, 01:45. The heart is a pump. Increased preload refers to increased fluid in the heart. If the pump does not function well, the fluid will back-up into other organs.
Question 2 of 10

2. Question

In which of the following types of cardiomyopathy are the ventricles not able to relax properly during diastole?

Restrictive cardiomyopathy

Non-compaction cardiomyopathy

Dilated cardiomyopathy

Hypertrophic cardiomyopathy

Hint

Hint: Chapter 1, 3:30. In this type of cardiomyopathy, the systolic function (the pumping of the heart) is preserved. Because the ventricles cannot relax, the blood backs-up into the atria and then either into the lungs or systemic circulation based on which side of the heart is affected (left versus right).
Question 3 of 10

3. Question

Which of the following equations related to cardiac output is correct?

Contractility = Cardiac Output x Stroke Volume

Cardiac Output = Stroke Volume / Heart Rate

Cardiac Output = Stroke Volume x Heart Rate

Contractility = Cardiac Output / Stroke Volume

Hint

Hint: Chapter 1, 07:00. Cardiac Output refers the volume of blood that is pumped by the heart in one minute.
Question 4 of 10

4. Question

Which of the following can be seen in a patient with ventricular dysfunction?

Increased Contractility

Increased Cardiac Output

Increased Stroke Volume

Increased Heart Rate

Hint

Hint: Chapter 1, 07:00. In ventricular dysfunction, the heart cannot squeeze properly, so its contractility and therefore the stroke volume are impaired. The heart tries to maintain its cardiac output by adjusting how fast it beats.
Question 5 of 10

5. Question

You are seeing a 10 year- old patient in clinic with a known congenital heart defect. On history, he tells you he feels very comfortable at rest with no difficulty breathing, fatigue, chest pain or palpitations. When he plays soccer, he occasionally has to stop to catch his breath. Given this history what class of heart failure does he have according to the New York Heart Association Heart Failure classification system?

Class I (mild)

Class II (mild)

Class III (moderate)

Class IV (severe)

Hint

Hint: Chapter 2, 00:18. He is asymptomatic at rest, but has some limitations in physical activity.
Question 6 of 10

6. Question

A 15 month-old girl with a known congenital heart defect presents with tachypnea and shortness of breath at rest. Her mother comments her tachypnea and shortness of breath is worse when eating or walking. Her weight-for-age has dropped to the 2^nd percentile on her growth curve. Using the Ross Classification for Heart Failure, what class heart failure does she have?

Class I (mild)

Class II (mild)

Class IV (severe)

Class III (moderate)

Hint

Hint: Chapter 2, 01:23. This patient is symptomatic at rest and with exertion and is having failure to thrive.
Question 7 of 10

7. Question

Which of the following best describes a patient who would be classified as having Stage A heart failure?

2 year old boy with a dilated cardiomyopathy who is asymptomatic with normal cardiac function by echocardiogram

2 year old boy with a dilated cardiomyopathy who is asymptomatic with mildly decreased cardiac function by echocardiogram

2 year old boy with dilated cardiomyopathy who has tachypnea and shortness of breath with exercise with decreased cardiac function by echocardiogram

2 year old boy with dilated cardiomyopathy who has tachypnea and shortness of breath at rest with decreased cardiac function by echocardiogram

Hint

Hint: Chapter 2, 03:04; Stage A patients have an underlying risk of heart disease but does not have any symptoms of heart failure and has normal cardiac function.
Question 8 of 10

8. Question

You see a patient with a history of dilated cardiomyopathy. The history, physical exam and echocardiogram confirm that he has Stage A heart failure. What intervention should you propose to the family?

Start an Angiotensin Converting Enzyme medication to decrease afterload

Start Angiotensin Converting Enzyme and consider adding low dose digoxin or diuretics

Admit to the hospital for mechanical circulatory support

Increased surveillance, no therapy required at this time

Hint

Hint: Chapter 2, 04:28. Stage A heart failure is the least severe and these patients do not have any signs or symptoms of heart failure
Question 9 of 10

9. Question

You are seeing a 6 year old previously healthy boy presenting with difficulty breathing and worsening cough of 2 weeks duration. He reports fatigue and diffuse abdominal discomfort. On physical exam, he is afebrile with an audible dry cough. Lung exam reveals diffuse crackles and end-expiratory wheezes at the lung bases bilaterally. What should you do next to further evaluate the cause of symptoms in this patient?

Obtain a chest x-ray

Trial a dose of albuterol

Given him a dose of diuretic

Draw blood culture and give him a dose of antibiotics

Hint

Hint: Chapter 3, 00:51. In young children, heart failure can be mistaken for asthma, viral syndrome, gastroentritis. The next step in your management should be to assess for cardiomegaly and evidence of pulmonary edema.
Question 10 of 10

10. Question
You are evaluating a patient with end-stage heart failure for possible heart transplantation. Which of the following do you expect to see on his blood tests?
Decreased creatinine

Normal liver function tests

Compensatory increase in hematocrit

Low brain natriuretic peptide (BNP)
Hint

Hint: Chapter 4, 00:46. Patients with severe heart failure and chronic low cardiac output have evidence of end-organ hypoperfusion and evidence of compensatory mechanisms to increase oxygen delivery.

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