PAEA STUDY GUIDE COMPLETE QUESTIONS WITH VERIFIED SOLUTIONS

PAEA STUDY GUIDE COMPLETE
QUESTIONS WITH VERIFIED SOLUTIONS

●● decreased ejection fraction, thin ventricular walls, dilated LV
chamber, and an S3 gallop (filling of dilated ventricle) is associated with
systolic or diastolic heart failure?
Answer: systolic (MC form of CHF)


*(the sound is actually heard in the diastole though)
-memory trick: "sys-to-lic" 3 consonants = S3


●● normal ejection fraction, thick ventricular walls, narrowed LV
chamber, and an S4 gallop (atrial contraction into a stiff ventricle) is
associated with systolic or diastolic heart failure?
Answer: diastolic


-memory trick: "di-a-sto-lic" 4 consonants = S4


●● what are the causes of systolic vs diastolic heart failure?
Answer: -systolic: post *MI*, *dilated cardiomyopathy*, myocarditis
-diastolic: *HTN*, *LVH*, *elderly*, valvular heart dz, hypertrophic or
restrictive cardiomyopathy, constrictive pericarditis

,●● when the metabolic demands of the body exceed normal cardiac
function (d/t thyrotoxicosis, wet beriberi, severe anemia, AV shunting,
Paget's disease of the bone) this is termed ________ heart failure
Answer: high-output


*fairly uncommon
-low-output HF is just d/t problem w/ myocardial contraction, ischemia,
or chronic HTN


●● what are some causes of acute vs chronic heart failure?
Answer: -acute: *largely systolic*; hypertensive crisis, acute MI,
papillary muscle rupture
-chronic: dilated cardiomyopathy (systolic), valvular dz (diastolic)


●● explain class I-IV New York Heart Association functional classes
Answer: -class I: *no sx's*, *no limitation* during ordinary physical
activity
-class II: *mild sx's* (dyspnea or angina), *slight limitation* during
ordinary activity
-class III: *comfortable only at rest* (sx's caused maked limitation in
activity even with minimal exertion
-class IV: *sx's even while at rest*, severe limitations, inability to carry
out physical activity

,●● what compensations does the body make when heart failure (can be
due to something that causes either inc pre/afterload or dec contractility)
begins?
Answer: 1. sympathetic nervous system activation
2. myocyte hypertrophy/remodeling
3. RAAS activation: fluid overload


●● the following are signs/sx's of what sided heart failure?
inc pulmonary venous pressure, dyspnea, orthopnea, rales/rhonchi,
chronic non-productive cough with pink frothy sputum, HTN, Cheyne-
Stokes breathing, S3 or S4, pale skin/cool extremities, sinus tachy,
fatigue
Answer: L-sided HF


●● the following are signs/sx's of what sided heart failure?
inc systemic venous pressure, peripheral edema, JVD, anorexia, N/V,
hepatosplenomegaly, RUQ tenderness, hepatojugular reflex (inc JVP
with liver palpation)
Answer: R-sided HF


●● -CXR showing Kerley B lines (alternate flow tracts), cardiomegaly,
pleural effusion, pulmonary edema
-echo with dec EF
-inc BNP on labs

, are all signs of?
Answer: heart failure


*BNP released from atrium with preload too high (volume overload)


●● what drugs have shown to decrease mortality rates in pts with heart
failure?
Answer: *ACE inhibitors* (-prils), ARBs, *beta-blockers* (-lols),
hydralazine + nitrates, spironolactone


●● in pts who experience the following common side effects of an ACE
inhibitor to treat heart failure, what is the alternative medication?
-1st dose hypotension, renal insufficiency, hyperkalemia, cough,
angioedema
Answer: ARBs (-sartans)


●● what vasodilators are often used to treat heart failure?
Answer: hydralazine + nitrates
-good for african americans
-safe in pregnancy
-acts to dec pre/afterload
-used if pt not able to tolerate ACEi/ARBs/BB or if more control needed