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Clinical Review Quiz

  Diastolic Dysfunction and Its Management in Elderly Patients

Reza Vafadouste, MD

Dr. Vafadouste is an attending physician, Department of Emergency Medicine, Nassau University Medical Center, East Meadow, NY; and an Assistant Professor of Cardiology, Stony Brook University Hospital, Stony Brook, NY

The questions below are based on the July 2002 cover article, “Diastolic Dysfunction and Its Management in Elderly Patients.”

Choose the single best answer for each question.

1. Diastolic congestive heart failure (CHF) can best be distinguished from systolic CHF on the basis of findings from which of the following?
  1. History
  2. Physical examination
  3. Chest radiography
  4. Echocardiography
  5. Ultrasonography
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2. Which of the following is NOT a major characteristic of diastolic CHF?

  1. Association with normal or small left ventricular cavity size with significant hypertrophy
  2. Association with normal or supernormal contractility
  3. Male preponderance
  4. Occurrence in older patients
  5. Occurrence in patients with a history of hypertension
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3. Which of the following conclusions can be drawn from the results of the Digitalis Investigation Group trial?

  1. Digoxin has no role in the treatment of diastolic CHF
  2. Digoxin is contraindicated in elderly patients with diastolic CHF
  3. Digoxin is highly effective in the treatment of patients with isolated diastolic heart failure
  4. Digoxin can improve symptoms and decrease hospitalization in patients with isolated diastolic CHF
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4. A 70-year-old man comes to the emergency department with signs and symptoms of CHF. A chest radiograph confirms the presence of pulmonary edema, and results of echocardiography reveal normal left ventricular systolic function. Regarding the use of diuretics in this patient, which of the following statements is most accurate?
  1. Administration of diuretics is the most appropriate therapy for this patient’s CHF
  2. Diuretics are contraindicated, because the patient has normal systolic function
  3. Diuretics should be used cautiously in this patient, because stroke volume may be dependent on preload
  4. High dosages of diuretics are appropriate, because the patient is at risk for death from pulmonary edema
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5. Which of the following tests can help to distinguish left ventricular systolic dysfunction from diastolic dysfunction?

  1. Chest radiography
  2. Contrast or radionuclide ventriculography
  3. Electrocardiography
  4. Ultrasonography
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