心衰问答优选课件.ppt

1、Question 1Ten year survival after the onset of heart failure:2020/10/181Prognosis in Heart Failure Men over 45 years of Age020406080100012345678910General PopulationMyocardial InfarctHeart FailureSurviving(%)Years from Diagnosis2020/10/182Prognosis in Heart Failure Women over 45 years of Age02040608

2、0100012345678910General PopulationMyocardial InfarctHeart FailureSurviving(%)Years from Diagnosis2020/10/183Question 2Potential underlying causes of heart failure include:2020/10/184Heart FailureThe Final Common Pathway HeartFailure2020/10/185Question 3The pathophysiology of heart failure can best b

3、e described as:2020/10/186Physiologic Response to Heart FailureLV Dysfunction Renal-AdrenalCarotid and LA Baroreceptors Renin-AngiotensinAldosteroneSympathetic OutputSodiumand fluidretentiontachycardiavasoconstriction2020/10/187Question 4Physiologic effects of Angiotensin II include:2020/10/188Renin

4、-Angiotensin SystemReninAngiotensin IAngiotensin II decreasedrenal perfusion decreasedNa deliverysympathetic activityAVP ReleasevasoconstrictionaldosteroneIncreased thirstNE releasesodium retentiondecreased GFR2020/10/189Question 5The following is a feature of the heart failure state:2020/10/1810Com

5、pensatory Mechanisms in Heart Failure2020/10/1811Question 6Patients with early heart failure typically present with:2020/10/1812Heart Failure Clinical Manifestations2020/10/1813Dyspnea Clinical Presentations2020/10/1814NYHA Functional Classification2020/10/1815Question 7Edema in heart failure takes

6、the following form:2020/10/1816Edema Clinical Presentations2020/10/1817Question 8Signs of right heart failure include all the following except:2020/10/1818Left vs Right Heart Failure2020/10/1819Question 9A diagnosis of heart failure is best extablished on the basis of the following:2020/10/1820Crite

7、ria for Diagnosis of CHF8-12 points-definite CHF5-7 points -possible CHF 5 points -unlikely CHF2020/10/1821Question 10All the following medications can precipitate heart failure in susceptible patient except:2020/10/1822Precipitating Causes of Heart Failure1.ischemia2.change in diet,drugs or both3.i

8、ncreased emotional or physical stress4.cardiac arrhythmias(eg.atrial fib)5.infection6.concurrent illness7.uncontrolled hypertension8.New high output state(anemia,thyroid)9.pulmonary embolism10.Mechanical disruption(sudden MR,VSD,AR)2020/10/1823Question 11The following investigations should always be

9、 carried out in patient presenting with heart failure except:2020/10/1824Investigations for Heart Failure 2020/10/1825Question 12Patient A.B.presents with clear signs of left heart failure and responds quickly to standard therapy.Follow-up assessment reveals normal LV systolic function.The most like

10、ly underlying cause of this patients heart failure is:2020/10/1826Heart Failure with Normal LV systolic function between symptomatic episodes2020/10/1827Question 13The following mechanisms contribute to myocardial dysfunction in heart failure patients:2020/10/1828Rationale for Treatment of Heart Fai

11、lureLV dysfunctionsympathetic activation Renin-angiotensin Adrenalstimulation epinephrinenorepinephrineangiotensin Ialdosteroneangiotensin II2020/10/1829Question 14All of the following have been shown to improve prognosis in patients with heart failure except:2020/10/1830Medical Management of Heart

12、Failure2020/10/1831Rationale for Treatment of Heart FailureLV dysfunctionsympathetic activation Renin-angiotensin Adrenalstimulation epinephrinenorepinephrineangiotensin Ialdosteroneangiotensin IIBABsACEIsARBsspironolactone2020/10/1832Beta Blocker Trials05101520US CARVCIBISMERITBESTCOPERNPlaceboTrea

13、tedMortality per year2020/10/1833Enalapril vs Placebo in Symptomatic CHFCONSENSUS00.10.20.30.40.50.60.70123456789101112PlaceboEnalaprilProbability of DeathMonths2020/10/1834Question 15The following are all adverse effects of beta blockers except:2020/10/1835Beta BlockersAdverse Effects2020/10/1836Be

14、ta Blockers in Heart FailurePractical Tips2020/10/1837Question 16The following are all adverse effects of ACE Inhibitors except:2020/10/1838ACE InhibitorsAdverse Effects2020/10/1839Question 17Current evidence supports the following approach with respect to digoxin:2020/10/1840Digitalis and other Ino

15、tropic DrugsRecommendations2020/10/1841Question 18Current evidence supports the following approach with respect to Angiotensin receptor antagonists:2020/10/1842Angiotensin Receptor BlockersIndications2020/10/1843Angiotensin Receptor BlockersAdverse Effects2020/10/1844Question 19Current evidence supp

16、orts the following approach with respect to Aldosterone antagonists:2020/10/1845Aldosterone Antagonists in Heart FailureEvidence2020/10/1846Aldosterone Antagonists in Heart FailureIndications2020/10/1847Question 20Current evidence supports the following approach with respect to diuretics:2020/10/184

17、8Diuretics in Heart Failure2020/10/1849Diuretics in Heart FailureAgents Used2020/10/1850Question 21The following are all adverse effects of furosemide except:2020/10/1851Diuretics in Heart FailureAdverse Effects2020/10/1852Question 22The following are all options to consider in patients with highly

18、symptomatic and refractory heart failure except:2020/10/1853Patients with:hypertension CAD DM risk for CMPPatients with:prior MI LV systolic dysfunction asymptomatic valve diseasePatients with:known structural heart disease SOB fatigue exercise tolerancePatients with:marked symptoms despite full the

19、rapyTherapytreat RFsencourage exercisediscourage alcoholTherapyall for Stage AACEIsBABsTherapyall for Stages A and Bdirueticsdigoxindietary restrictionsTherapyall for ABCassist devices transplantation Structural heart diseaseSymptoms of Heart FailureRefractory SymptomsSTAGE ASTAGE BSTAGE CSTAGE DAt

20、risk2020/10/1854Question 23The following all support the diagnosis of acute pericarditis except:2020/10/1855Acute Pericarditis Diagnostic Criteria2020/10/1856Question 24The earliest EKG changes seen in acute pericarditis:2020/10/1857EKG in Acute Pericarditis2020/10/1858Question 25Pericardial tampona

21、de should be suspected in the following situations:2020/10/1859Pericardial TamponadePhysical Examination Findings2020/10/1860Question 26Causes of pericardial effusions include all of the following except:2020/10/1861Pericarditis-causes2020/10/1862Question 27Constrictive pericarditis should be includ

22、ed in the differential diagnosis of:2020/10/1863Constrictive PericarditisDifferential Diagnosis2020/10/1864Question 28The most common site of infection in patients with Infectious Endocaridits:2020/10/1865Sites of Infection86552010102030405060708090Percent of CasesMitralAorticTricuspidPulmonic2020/1

23、0/1866Question 29The most common infecting organism in patients with right sided endocarditis:2020/10/1867Infective EndocarditisMicroorganisms ResponsibleNative ValvesIVDAsProsthetic ValvesStrep Viridans 30-40%5-20%Enterococci 5-15%8-10%5-10%Other Strep 15-20%10-15%1-5%Staph aureus 10-30%50-60%15-20

24、%Staph epiderm 1-3%2-5%20-30%Gm ve bacilli 2-10%4-8%10-20%Fungi 2-4%4-5%5-15%Diphtheroids 2-4%1-2%5-10%Miscellaneous 2-5%1%0-2%Culture negative 5-10%5-8%5%2020/10/1868Question 30Underlying predispositions to the development of Infectious Endocarditis include:2020/10/1869谢谢您的聆听与观看THANK YOU FOR YOUR GUIDANCE.感谢阅读！为了方便学习和使用，本文档的内容可以在下载后随意修改，调整和打印。欢迎下载！汇报人：XXX日期：20XX年XX月XX日