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Chapter 6. Heart Failure

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Which of the following finding, when reduced, indicates impaired systolic function in a patient with heart failure?

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A. BNP

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B. SCr

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C. LVEF

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D. LVH

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E. Troponin

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What is the most common etiology of heart failure?

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A. Ischemic

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B. Idiopathic, unknown cause

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C. Viral cardiomyopathy

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D. Drug-induced

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E. Hypertension

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A 58-year-old man presents to the clinic today with complaints of increasing shortness of breath while dressing and carrying groceries and a 10 lb (4.5 kg) weight gain. A few months prior, he noticed episodes of waking in the middle of the night with shortness of breath, difficulty breathing after walking two flights of stairs, as well as ankle edema. The patient has a history of osteoarthritis × 10 years, hypertension × 4 years, diabetes mellitus × 5 years, dyslipidemia, and is status post myocardial infarction 2 years ago.

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Physical exam reveals the following: BP 148/96 mmHg, pulse 98 beats/min, Ht: 5’11’’ (180 cm), Wt: 189 lb (86 kg; usual = 178 lb [81 kg]), BMI: 26.4 kg/m2

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(+) JVD, (-) HJR or hepatomegaly

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(+) S3, (+) S4

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ECG: regular rate/rhythm, evidence of old infarct

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ECHO: EF 33% (0.33)

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CXR: Crackles bilaterally and cardiomegaly (enlarged heart)

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Labs:

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Sodium: 142 mE/L (142 mmol/L)

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Potassium: 3.7 mEq/L (3.7 mmol/L)

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Magnesium: 1.8 mEq/L (0.90 mmol/L)

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BUN: 22 mg/dL (7.9 mmol/L)

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SCr: 1.3 mg/dL (115 μmol/L)

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BNP: 322 pg/mL (322 ng/L; 93 pmol/L)

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Current medications:

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Aspirin 81 mg daily

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Diltiazem 180 mg daily

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Glipizide 10 mg twice daily for diabetes

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Simvastatin 20 mg nightly at bedtime

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Acetaminophen 500 mg twice daily

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Which of the patient’s medications can exacerbate systolic dysfunction heart failure?

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A. Glipizide

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B. Diltiazem

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C. Acetaminophen

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D. b and c

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E. All of the above

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A 58-year-old man presents to the clinic today with complaints of increasing shortness of breath while dressing and carrying groceries and a 10 lb (4.5 kg) weight gain. A few months ...

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