When the heart can no long pump sufficiently to meet the body’s requirements, the patient has entered formal “heart failure”.  This quiz runs through the fundamentals of heart failure pathophysiology.  Good luck!

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Pathophysiology of Heart Failure

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Question 1
What forms ESV?
A
Contractility + afterload
B
Contractility + preload
C
Preload and afterload
D
None of the above
Question 2
Which of the following is a classic sign of heart failure?
A
Dyspnoea
B
Ankle swelling
C
Fatigue
D
JVP elevation
Question 3

Stem 1 of 4

A patient with thirty year history of smoking and dyslipidaemia presents with dyspnoea causing them to awaken at night, inability to lie down without struggling to breathe, intense fatigue and peripheral oedema.
What do you expect on auscultation of the patient's lung bases?
A
Bibasal crackles
B
Wheeze
C
Stridor
D
Absent breath sounds
Question 4

Stem 2 of 4

There are 33,000,000 people in the UK over 40 as of 2019 (Source ONS, 2019).  Given your knowledge of the epidemiology, how many of those will be diagnosed with the heart failure?
A
6.6 million
B
8.9 million
C
12.2 million
D
10.8 million
Question 4 Explanation: 
20% of the >40YO population of the UK today will be diagnosed with heart failure in their lifetime. 33*0.2 = 6.6.
Question 5

Stem 3 of 4

The patient has a a notable previous history of thyrotoxicosis. Of which class of heart failure aetiology is the patient related to?  
A
CAD
B
Conduction arrhythmia
C
Valvular defect
D
Increased CO
Question 6

Stem 4 of 4

The patient's heart failure is now due to insufficient contractility to maintain adequate CO. What is this type of heart failure termed?
A
Diastolic heart failure
B
Congenital heart failure
C
HFrEF
D
HFpEF
Question 7
When listening to the patient with HFpEF, what sound can be heard aberrantly in the cardiac region?
A
S1
B
S2
C
S3
D
S4
Question 7 Explanation: 
At this stage of heart failure, CO is relatively maintained. Thus the heart has not undergone dilatation and hypertrophy has occurred. In this instance, this means that a heart sound is heard as "S4" just before the S1 heart sound.
Question 8
Which of the following is a negative of echocardiography
A
Cost
B
Structural identification
C
Functional Identification
D
Nature of result interpretation
Question 8 Explanation: 
Echo interpretation is incredibly subjective and requires a higher degree of training than most imaging modalities to be competent.
Question 9
Which of the following demonstrates light microscopic observation of ventricular remodelling?
A
Loss of muscle mass
B
Dys-synchronus contractions
C
Disorganised cytoskeleton
D
ECM changes
Question 10
Which of the following is a sign of LVHF?
A
Peripheral oedema
B
GI congestion
C
Asterixis
D
PND
Question 11
Which of the following is a sign of RVHF?
A
Activity intolerance
B
Jaundice
C
Central cyanosis
D
Pink, frothy sputum
Question 12
Two patients are present in AMU.
One patient presented with cold peripheries, elevated JVP and bradycardia.  The second presented with dyspnoea on lying down, central cyanosis and inability to walk due to fatigue.
Which patient is in acute heart failure?
A
First patient
B
Second patient
C
Both patients
D
Neither patient
Question 13
A patient is discussing their activities of daily living with their cardiologist. They state that they have much less activity than they used to but they are still quite comfortable at rest.  They are worried that even going to the toilet, or walking in their small garden, causes difficulty in breathing and fatigue readily.
According to the New York Heart Association Heart Failure Classification scale, where is this patient to be placed?
A
Class I
B
Class II
C
Class III
D
Class IV
Question 14
Which best defines Frank-Starling's law of diffusion?
A
NFP is proportional to hydraulic pressure plus COP
B
COP is proportional to hydraulic pressure plus NFP
C
NFP is proportional to hydraulic pressure minus COP
D
COP is proportional to NFP minus hydraulic pressure
Question 15
As renal perfusion is decreased in LVHF, what is the concomitant increase from the renal interstitial cells?
A
Renin
B
NO
C
ANP
D
ATI
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