ABFM + KSA Heart Disease (Latest
Update ) Questions &
Answers | Grade A | 100% Correct
(Verified Answers)
A 65-year-old female who has heart failure with an ejection fraction of 35% is found to
have a TSH level of 13.8 µU/mL (N 0.3-4.82). Her T3 and T4 levels are normal, and her
thyroid gland is normal to palpation. You check her levels again in 2 months and they
are unchanged. You advise her that
hypothyroidism decreases her metabolic rate, which reduces the stress on her heart
hypothyroidism is detrimental to her heart only if she develops hypothyroid symptoms
subclinical hypothyroidism has negative effects on heart failure and treatment should be
considered
treatment of subclinical hypothyroidism would raise her LDL-cholesterol level -
CORRECTANSWER C
Clinical hypothyroidism has long been associated with cardiac dysfunction. It has also
been shown that subclinical hypothyroidism (TSH >4 µU/mL with normal or borderline
low thyroid hormone levels) can cause left ventricular systolic and diastolic dysfunction,
which improves with thyroid replacement therapy. Patients with overt or subclinical
hypothyroidism should be treated with levothyroxine to improve their cardiovascular
function and decrease the potential risk of heart failure. Thyroxine in excess can
,exacerbate coronary artery disease, and should be started at low doses and increased
slowly in patients with possible underlying coronary artery disease. Results of meta-
analyses indicate that therapy will lower, not raise, serum LDL-cholesterol levels.
A 58-year-old male is hospitalized with severe decompensated heart failure refractory to
intravenous inotropic therapy and guideline-directed medical therapy. You are
considering referral to a tertiary care hospital for mechanical circulatory support to
bridge to transplantation.Which one of the following is true regarding mechanical
circulatory support bridge therapy?
It should be limited to patients who meet the criteria for heart transplantation
It should only be used in patients with biventricular heart failure
It generally improves quality of life while waiting for transplantation
It greatly reduces quality of life while waiting for transplantation -CORRECTANSWER c
Mechanical circulatory support (MCS) with a ventricular assist device has continued to
evolve and has emerged as a viable therapeutic option for patients with advanced stage
D heart failure with reduced ejection fraction refractory to guideline-directed medical
therapy and cardiac device intervention. A variety of ventricular assist devices are now
available. These devices may be either intracorporeal or extracorporeal, and may be
designed to assist the left ventricle, right ventricle, or both.Bridge therapy refers to the
use of left ventricular assist devices to help a patient survive until a donor heart
becomes available for transplantation. Several devices are available, some of which are
,implantable and allow patients to be discharged to their homes. These devices can
increase patient activity levels and quality of life. Complications can occur, including
stroke, infection, and death, but these devices can be lifesaving in patients with
refractory heart failure.The data from the Interagency Registry for Mechanically Assisted
Circulatory Support indicates that cardiogenic shock, advanced age, and severe right
heart failure (manifested as ascites or increased bilirubin) are major risk factors for
death after MCS. This led to a recommendation that referral for MCS be considered
before severe right ventricular failure develops. Possible indications for a bridge-to-
candidacy ventricular assist device include obesity, tobacco use, and severe pulmonary
hypertension in patients who might otherwise be candidates for transplantation.
An active 66-year-old female presents with intermittent chest pain and dyspnea. She is
currently pain free. A resting EKG is normal.If found on the history and examination,
which one of the following symptoms is most likely to be associated with myocardial
ischemia as the cause of chest pain?
An episode of diaphoresis associated with the chest pain
Pain reproduced by chest wall palpation on the left side of the chest
Pain that comes and goes with and without exertion
Intermittent pleuritic-type pain and dyspnea -CORRECTANSWER A
Cardiac ischemia is classically defined as deep, poorly localized chest or arm
discomfort reproducibly associated with exertion or emotional stress. It is relieved with
, rest and nitroglycerin. It can present in an atypical fashion, and the discomfort can
localize or radiate to the neck, lower jaw, throat, shoulder, epigastrium, hands, or upper
back. It may be entirely absent in some cases. In older patients without chest pain, new-
onset or unexplained exertional dyspnea is the most common anginal equivalent, even
with a normal resting EKG.Although they may be present, pleuritic-type pain, pain
reproduced with movement or palpation of the chest wall or arm, and sharp or stabbing
pain are not characteristic features of myocardial ischemia. Very brief episodes of pain,
lasting a few seconds or less, are also not characteristic of myocardial ischemia. In a
meta-analysis of symptoms useful in diagnosing acute coronary syndrome in a low-risk
setting, diaphoresis was found to be the strongest predictor of myocardial infarction (MI)
(likelihood ratio [LR] = 2.44), and the presence of chest wall tenderness significantly
reduced the possibility of MI (LR = 0.23). A completely normal EKG does not exclude
the possibility of acute coronary syndrome because 1%-6% of such patients eventually
are found to have an acute myocardial infarction (non-ST-segment elevation by
definition) and at least 4% have unstable angina.
A 69-year-old female with a history of chronic hypertension and a previous myocardial
infarction sees you for follow-up 6 weeks after being hospitalized for chest pain. During
her hospitalization she underwent cardiac catheterization, which showed only a lesion in
the circumflex that was less than 50% occluded. An EKG revealed sinus bradycardia of
52 beats/min, multifocal PVCs, and a QRS interval of 0.10 sec. Echocardiography
revealed a left ventricular ejection fraction of 32%.Although the patient feels comfortable
at rest she reports that she has difficulty walking up a single flight of stairs. Her current
Update ) Questions &
Answers | Grade A | 100% Correct
(Verified Answers)
A 65-year-old female who has heart failure with an ejection fraction of 35% is found to
have a TSH level of 13.8 µU/mL (N 0.3-4.82). Her T3 and T4 levels are normal, and her
thyroid gland is normal to palpation. You check her levels again in 2 months and they
are unchanged. You advise her that
hypothyroidism decreases her metabolic rate, which reduces the stress on her heart
hypothyroidism is detrimental to her heart only if she develops hypothyroid symptoms
subclinical hypothyroidism has negative effects on heart failure and treatment should be
considered
treatment of subclinical hypothyroidism would raise her LDL-cholesterol level -
CORRECTANSWER C
Clinical hypothyroidism has long been associated with cardiac dysfunction. It has also
been shown that subclinical hypothyroidism (TSH >4 µU/mL with normal or borderline
low thyroid hormone levels) can cause left ventricular systolic and diastolic dysfunction,
which improves with thyroid replacement therapy. Patients with overt or subclinical
hypothyroidism should be treated with levothyroxine to improve their cardiovascular
function and decrease the potential risk of heart failure. Thyroxine in excess can
,exacerbate coronary artery disease, and should be started at low doses and increased
slowly in patients with possible underlying coronary artery disease. Results of meta-
analyses indicate that therapy will lower, not raise, serum LDL-cholesterol levels.
A 58-year-old male is hospitalized with severe decompensated heart failure refractory to
intravenous inotropic therapy and guideline-directed medical therapy. You are
considering referral to a tertiary care hospital for mechanical circulatory support to
bridge to transplantation.Which one of the following is true regarding mechanical
circulatory support bridge therapy?
It should be limited to patients who meet the criteria for heart transplantation
It should only be used in patients with biventricular heart failure
It generally improves quality of life while waiting for transplantation
It greatly reduces quality of life while waiting for transplantation -CORRECTANSWER c
Mechanical circulatory support (MCS) with a ventricular assist device has continued to
evolve and has emerged as a viable therapeutic option for patients with advanced stage
D heart failure with reduced ejection fraction refractory to guideline-directed medical
therapy and cardiac device intervention. A variety of ventricular assist devices are now
available. These devices may be either intracorporeal or extracorporeal, and may be
designed to assist the left ventricle, right ventricle, or both.Bridge therapy refers to the
use of left ventricular assist devices to help a patient survive until a donor heart
becomes available for transplantation. Several devices are available, some of which are
,implantable and allow patients to be discharged to their homes. These devices can
increase patient activity levels and quality of life. Complications can occur, including
stroke, infection, and death, but these devices can be lifesaving in patients with
refractory heart failure.The data from the Interagency Registry for Mechanically Assisted
Circulatory Support indicates that cardiogenic shock, advanced age, and severe right
heart failure (manifested as ascites or increased bilirubin) are major risk factors for
death after MCS. This led to a recommendation that referral for MCS be considered
before severe right ventricular failure develops. Possible indications for a bridge-to-
candidacy ventricular assist device include obesity, tobacco use, and severe pulmonary
hypertension in patients who might otherwise be candidates for transplantation.
An active 66-year-old female presents with intermittent chest pain and dyspnea. She is
currently pain free. A resting EKG is normal.If found on the history and examination,
which one of the following symptoms is most likely to be associated with myocardial
ischemia as the cause of chest pain?
An episode of diaphoresis associated with the chest pain
Pain reproduced by chest wall palpation on the left side of the chest
Pain that comes and goes with and without exertion
Intermittent pleuritic-type pain and dyspnea -CORRECTANSWER A
Cardiac ischemia is classically defined as deep, poorly localized chest or arm
discomfort reproducibly associated with exertion or emotional stress. It is relieved with
, rest and nitroglycerin. It can present in an atypical fashion, and the discomfort can
localize or radiate to the neck, lower jaw, throat, shoulder, epigastrium, hands, or upper
back. It may be entirely absent in some cases. In older patients without chest pain, new-
onset or unexplained exertional dyspnea is the most common anginal equivalent, even
with a normal resting EKG.Although they may be present, pleuritic-type pain, pain
reproduced with movement or palpation of the chest wall or arm, and sharp or stabbing
pain are not characteristic features of myocardial ischemia. Very brief episodes of pain,
lasting a few seconds or less, are also not characteristic of myocardial ischemia. In a
meta-analysis of symptoms useful in diagnosing acute coronary syndrome in a low-risk
setting, diaphoresis was found to be the strongest predictor of myocardial infarction (MI)
(likelihood ratio [LR] = 2.44), and the presence of chest wall tenderness significantly
reduced the possibility of MI (LR = 0.23). A completely normal EKG does not exclude
the possibility of acute coronary syndrome because 1%-6% of such patients eventually
are found to have an acute myocardial infarction (non-ST-segment elevation by
definition) and at least 4% have unstable angina.
A 69-year-old female with a history of chronic hypertension and a previous myocardial
infarction sees you for follow-up 6 weeks after being hospitalized for chest pain. During
her hospitalization she underwent cardiac catheterization, which showed only a lesion in
the circumflex that was less than 50% occluded. An EKG revealed sinus bradycardia of
52 beats/min, multifocal PVCs, and a QRS interval of 0.10 sec. Echocardiography
revealed a left ventricular ejection fraction of 32%.Although the patient feels comfortable
at rest she reports that she has difficulty walking up a single flight of stairs. Her current
