PAEA Internal Medicine Inpatient EOR Topics 2024/2025 Questions and Answers Complete;(everything on topic list except hematology (5%) and infectious disease (5%))

what is the most common cause of heart failure? specifically left sided? right sided? - -MC is CAD (coronary artery disease) -L sided: *CAD* & HTN -R sided: *L sided HF* & pulmonary dz 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? - 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? - diastolic -memory trick: "di-a-sto-lic" 4 consonants = S4 what are the causes of systolic vs diastolic heart failure? - -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 - 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? - -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 - -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? - 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 nonproductive cough with pink frothy sputum, HTN, Cheyne-Stokes breathing, S3 or S4, pale skin/cool extremities, sinus tachy, fatigue - 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) - 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? - 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? - *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 - ARBs (-sartans) what vasodilators are often used to treat heart failure? - 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 what is the most effective treatment for symptoms of heart failure? - diuretics -loop diuretics (-semides) act on inc excretion of Na, Cl, K, H2O (so can go hypo on these electrolytes), other s/e: hyperglycemia, hyperuricemia -K-sparing diuretics (spironolactone, eplerenone) aldosterone antagonists; s/e: hyperkalemia, gynecomastia with spirono -HCTZ or metolazone (thiazide like diuretic)- s/e: hyponatremia/kalemia, hyperuricemia, hyperglycemia