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Self-Assessment Questions

Cardiology

Management of Congestive Heart Failure: Review Questions

Lekshmi Dharmarajan, MD, FACP, FACC

Dr. Dharmarajan is a Clinical Associate Professor of Medicine, Weill Medical College of Cornell University, New York, NY; and Chief, Division of Cardiology, and Director, Coronary Care Unit, Lincoln Medical and Mental Health Center, Bronx, NY.


Choose the single best answer for each question.


1. Which of the following statements regarding congestive heart failure (CHF) is correct?
  1. Neurohormones do not play a role in cardiac remodeling or progression of CHF
  2. The most common etiology of CHF today is hypertensive heart disease
  3. The most useful diagnostic test for evaluating CHF is 2-D echocardiography with Doppler flow studies
  4. The New York Heart Association classification for heart failure correlates with ejection fraction
  5. The presence of dyspnea helps differentiate diastolic from systolic dysfunction
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2. Which of the following statements about the pharmacologic management of CHF is INCORRECT?

  1. Administration of diuretics is the only reliable means to control fluid retention in CHF
  2. Angiotensin-converting enzyme (ACE) inhibitors exert favorable effects on cardiac remodeling
  3. Combining hydralazine and nitrate is an alternative therapy for patients who cannot tolerate ACE inhibitors
  4. Digoxin significantly improves survival of patients with CHF
  5. Positive inotropic agents are not recommended for intravenous infusion in an outpatient setting
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3. Which of the following statements does NOT correctly describe the role of beta-blockers in CHF resulting from systolic dysfunction?

  1. Beta-blockers block the action of catecholamines, which are deleterious to the myocardium
  2. Beta-blockers improve ejection fraction in CHF
  3. Beta-blockers may enhance coronary blood flow
  4. Long-term use of beta-blockers risks worsening of CHF
  5. Use of beta-blockers decreases hospitalizations and improves patient survival
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  4. A 60-year-old man with idiopathic dilated cardiomyopathy is admitted to the intensive care unit with dyspnea. Medications include an ACE inhibitor, digoxin, and furosemide. Physical examination reveals a blood pressure of 100/60 mm Hg, engorged jugular veins, bilateral rales, an S3, and pedal edema. Chest radiography confirms pulmonary edema. The ejection fraction is 25% (low) on an echocardiogram. The patient improves with intravenous furosemide, as well as restriction of salt and fluid intake. Which of the following statements about the patient’s drug therapy is correct?
  1. Carvedilol therapy should have been initiated at the time of admission
  2. He should continue on the same regimen
  3. He should receive carvedilol once he is stable (preferably as an outpatient)
  4. The blood pressure of 100/60 mm Hg is a contraindication to use of carvedilol
  5. The low ejection fraction is a contraindication to use of carvedilol
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5. Which of the following statements regarding diuretic resistance in CHF is INCORRECT?

  1. Administration of slow-infusion loop diuretics helps overcome diuretic resistance
  2. Combining thiazide with a loop diuretic increases its efficacy
  3. Rapid, repeated intravenous administration of loop diuretics is safe
  4. Use of nonsteroidal anti-inflammatory drugs may contribute to diuretic resistance
  5. Worsening renal function requires administration of higher doses of diuretics
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