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ABFM HEART DISEASE questions and answers rated A+2025/2026
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ABFM HEART DISEASE questions and answers rated A+2025/2026
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ABFM HEART DISEASEA 65-yr-old girl who has coronary heart failure with an ejection fraction of 35% is located to
have a TSH stage of thirteen.Eight µU/mL (N zero.3-4.82). Her T3 and T4 tiers are everyday,
and her thyroid gland is regular to palpation. You check her ranges once more in 2 months
and they're unchanged. You advocate her that
hypothyroidism decreases her metabolic rate, which reduces the pressure on her heart
hypothyroidism is unfavorable to her heart only if she develops hypothyroid symptoms
subclinical hypothyroidism has poor outcomes on coronary heart failure and remedy ought to
be considered
treatment of subclinical hypothyroidism would enhance her LDL-cholesterol stage - ANSC
Clinical hypothyroidism has lengthy been related to cardiac dysfunction. It has also been
shown that subclinical hypothyroidism (TSH >4 µU/mL with ordinary or borderline low thyroid
hormone degrees) can reason left ventricular systolic and diastolic disorder, which improves
with thyroid replacement therapy. Patients with overt or subclinical hypothyroidism should be
dealt with with levothyroxine to improve their cardiovascular characteristic and decrease the
capability risk of coronary heart failure. Thyroxine in extra can exacerbate coronary artery
sickness, and must be commenced at low doses and improved slowly in patients with
feasible underlying coronary artery disease. Results of meta-analyses suggest that remedy
will lower, no longer raise, serum LDL-cholesterol levels.
A 58-yr-vintage male is hospitalized with excessive decompensated heart failure refractory
to intravenous inotropic remedy and tenet-directed medical therapy. You are considering
referral to a tertiary care medical institution for mechanical circulatory help to bridge to
transplantation.Which one of the following is true regarding mechanical circulatory help
bridge therapy?
It must be constrained to sufferers who meet the standards for heart transplantation
It must handiest be used in patients with biventricular heart failure
It generally improves pleasant of life while awaiting transplantation
It significantly reduces exceptional of life while waiting for transplantation - ANSc
Mechanical circulatory aid (MCS) with a ventricular help device has endured to evolve and
has emerged as a feasible healing choice for patients with superior degree D heart failure
with decreased ejection fraction refractory to tenet-directed medical therapy and cardiac tool
intervention. A sort of ventricular assist devices at the moment are to be had. These devices
can be both intracorporeal or extracorporeal, and can be designed to help the left ventricle,
right ventricle, or both.Bridge remedy refers to using left ventricular assist devices to help a
patient live on until a donor heart turns into available for transplantation. Several devices are
to be had, a number of which might be implantable and permit patients to be discharged to
their homes. These gadgets can boom affected person activity degrees and fine of
existence. Complications can arise, including stroke, infection, and death, but these devices
,may be lifesaving in sufferers with refractory heart failure.The information from the
Interagency Registry for Mechanically Assisted Circulatory Support indicates that
cardiogenic surprise, advanced age, and extreme proper coronary heart failure (manifested
as ascites or improved bilirubin) are principal hazard factors for dying after MCS. This
caused a advice that referral for MCS be taken into consideration earlier than severe proper
ventricular failure develops. Possible indications for a bridge-to-candidacy ventricular help
device encompass obesity, tobacco use, and severe pulmonary hypertension in sufferers
who might otherwise be candidates for transplantation.
An lively 66-12 months-antique woman gives with intermittent chest ache and dyspnea. She
is presently pain free. A resting EKG is regular.If discovered on the records and examination,
which one of the following signs and symptoms is most possibly to be related to myocardial
ischemia because the motive of chest pain?
An episode of diaphoresis related to the chest pain
Pain reproduced by using chest wall palpation at the left aspect of the chest
Pain that comes and is going with and with out exertion
Intermittent pleuritic-kind ache and dyspnea - ANSA
Cardiac ischemia is classically described as deep, poorly localized chest or arm pain
reproducibly associated with exertion or emotional pressure. It is relieved with rest and
nitroglycerin. It can found in an bizarre fashion, and the soreness can localize or radiate to
the neck, decrease jaw, throat, shoulder, epigastrium, arms, or higher back. It may be totally
absent in a few cases. In older sufferers without chest ache, new-onset or unexplained
exertional dyspnea is the most commonplace anginal equal, in spite of a regular resting
EKG.Although they'll be gift, pleuritic-type pain, pain reproduced with motion or palpation of
the chest wall or arm, and sharp or stabbing pain are not function capabilities of myocardial
ischemia. Very quick episodes of pain, lasting some seconds or much less, are also no
longer feature of myocardial ischemia. In a meta-analysis of symptoms beneficial in
diagnosing acute coronary syndrome in a low-chance placing, diaphoresis was determined
to be the most powerful predictor of myocardial infarction (MI) (probability ratio [LR] = 2.Forty
four), and the presence of chest wall tenderness considerably reduced the opportunity of MI
(LR = 0.23). A completely ordinary EKG does not exclude the opportunity of acute coronary
syndrome due to the fact 1%-6% of such sufferers eventually are determined to have an
acute myocardial infarction (non-ST-segment elevation by definition) and as a minimum
four% have volatile angina.
A sixty nine-yr-antique girl with a history of chronic high blood pressure and a previous
myocardial infarction sees you for follow-up 6 weeks after being hospitalized for chest pain.
During her hospitalization she underwent cardiac catheterization, which showed most
effective a lesion inside the circumflex that changed into much less than 50% occluded. An
EKG found out sinus bradycardia of 52 beats/min, multifocal PVCs, and a QRS interval of
0.10 sec. Echocardiography revealed a left ventricular ejection fraction of 32%.Although the
affected person feels comfy at rest she reviews that she has difficulty taking walks up a
unmarried flight of stairs. Her present day medicinal drugs consist of atorvastatin (Lipitor),
forty mg daily; lisinopril (Prinivil, Zestril), 20 mg daily; metoprolol succinate (Toprol-XL), one
hundred mg each day; furosemide (Lasix), 40 mg each day; and aspirin, 81 mg daily.On
,examination the affected person is not in acute distress. Her blood strain is 132/78 mm Hg
and her pulse fee - ANSD
Aldosterone antagonists are vital within the control of intense coronary heart failure. The
addition of an aldosterone antagonist to a β-blocker and an ACE inhibitor became shown
inside the Randomized Aldactone Evaluation Study to lessen rates of demise and health
center readmissions in decided on sufferers with moderate to intense signs of coronary heart
failure and a reduced left ventricular ejection fraction (LVEF) (SOR B). More these days, the
EMPHASIS-HF trial (Eplerenone in Mild Patients Hospitalization and Survival Study in Heart
Failure trial) found that the addition of eplerenone in coronary heart failure patients with
slight signs constant with New York Heart Association (NYHA) elegance II coronary heart
failure and a median LVEF of 26% led to a reduction in both hospitalizations and deaths.
Current American Heart Association hints advocate the addition of an aldosterone antagonist
to an ACE inhibitor and a β-blocker in decided on sufferers with moderately severe to
intense signs and symptoms of heart failure and a reduced LVEF.Although the addition of
digoxin may be of gain in selected heart failure patients by lowering the danger for
hospitalization, it has no longer been proven to reduce mortality (SOR B). According to latest
recommendations, patients are taken into consideration candidates for cardiac
resynchronization remedy if they have NYHA class II-IV coronary heart failure, a left
ventricular ejection fraction ≤35%, and a QRS duration >one hundred thirty ms on an EKG.
However, 30%-35% of sufferers who meet these criteria are nonresponders without a
symptomatic improvement or reverse left ventricular transforming. Left package department
block morphology, a QRS length ≥one hundred fifty ms, and ok coronary sinus anatomy
have been maximum closely related to a positive response. Mitral valve regurgitation, proper
ventricular dysfunction, and atrial fibrillation have been proven to have a negative impact on
patient r
You admit a affected person with acute coronary syndrome to the clinic. Which one of the
following is real regarding the differences among low molecular weight heparin (LMWH) and
unfractionated heparin (UFH) in this example?
The use of glycoprotein IIb/IIIa inhibitors does no longer require a trade in the dosage of
UFH
The dosage of both must be titrated to reap a partial thromboplastin time of one.5-2.5 times
manage
Platelet activation is the equal for both
The prevalence of thrombocytopenia is decrease with LMWH
UFH has higher bioavailability due to the fact it's far given intravenously - ANSD
Anticoagulation is usually recommended similarly to antiplatelet remedy for all patients with
acute coronary syndrome regardless of the preliminary remedy approach. For patients
managed with an early invasive approach, heparin exerts its anticoagulant impact via
accelerating the action of circulating antithrombin. It is available as either intravenous
unfractionated heparin (UFH) or subcutaneous low molecular weight heparin
(LMWH).LMWH gives greater bioavailability than UFH due to decreased binding to plasma
proteins and endothelial cells, and it effects in much less platelet activation. The occurrence
of thrombocytopenia in patients dealt with with LMWH is much less than with UFH. LMWH
does now not exchange the partial thromboplastin time (PTT) significantly, so PTT should
, not be used to display the dosage. LMWH is a viable choice for remedy of acute coronary
artery syndrome and is desired in many conditions.If UFH is used it ought to accept
intravenously at a dosage of 85 U/kg unless a glycoprotein IIb/IIIa inhibitor is also
administered, in which case the dosage need to be decreased to 60 U/kg. Dosing
modifications have to be based totally at the goal activated clotting time. Patients handled
with UFH must be monitored by way of component Xa assays.
An eighty two-year-old female gives with growing dyspnea. Her husband is concerned
because she every now and then stops respiration when she is asleep. You had been
treating the patient for heart failure for the past 2 years with ACE inhibitors, β-blockers,
diuretics, and low-dose spironolactone (Aldactone). The nurse who measures the patient's
blood pressure notes that the systolic sounds are heard first at a stress of a hundred thirty
five mm Hg and a pulse fee of forty beats/min. At 120 mm Hg the nurse hears Korotkoff
sounds at a everyday price of eighty/min.Which one of the following is true concerning this
patient?
The examination findings are ordinary for patients in this age institution
The patient's respiration pattern is regular for patients on this age group
Both the respiration and blood pressure findings may additionally improve with more
intensive remedy
Medications must be reduced in this patient because her blood pressure is risky - ANSC
This patient has pulsus alternans, that is not unusual in sufferers with decompensated
coronary heart failure and advanced myocardial ailment. Effective remedy can make this
finding disappear. Cheyne-Stokes respiration is also common in patients with
decompensated heart failure. If the heart failure is treated, the respiratory abnormality can
disappear. The patient has symptomatic coronary heart failure, which classifies her coronary
heart failure as degree C at the least, consistent with the American College of
Cardiology/American Heart Association heart failure recommendations.
A 69-year-old girl gives to the emergency department with a 1-hour episode of severe
substernal chest pain that has now resolved. Her beyond medical history is great for current
tobacco abuse, high blood pressure, and despair. Her cutting-edge medicinal drugs include
lisinopril/hydrochlorothiazide (Zestoretic), 10/12.Five mg daily; citalopram (Celexa), 20 mg
each day; and aspirin, 81 mg daily. On examination she has a blood strain of one hundred
fifty/ninety two mm Hg and a pulse charge of ninety two beats/min. An EKG exhibits a sinus
rhythm with deep and symmetrical T-wave inversions inside the inferior leads.You determine
to confess the patient to the clinic. Which one of the following must be administered on
admission?
Alteplase (Activase) intravenously
Aspirin, eighty one mg, and nitroglycerin through intravenous drip
Enoxaparin (Lovenox), 1 mg/kg subcutaneously, and nitroglycerin, zero.Four mg sublingually
Ticagrelor (Brilinta), 60 mg orally, and enoxaparin, 1 mg/kg subcutaneou - ANSE
The control of volatile angina or non-ST-elevation myocardial infarction (NSTEMI) is much
like the management of ST-elevation myocardial infarction except that fibrinolytic remedy
has no role in unstable angina or NSTEMI (SOR A). Studies indicate that fibrinolytic therapy
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