2018 Board Review Pre-Test:
Drug Therapy for Chronic Heart Failure I

Drug Therapy for Chronic Heart Failure I - Mark Drazner, MD, FHFSA

Please complete this brief Pre-Test to give a baseline for learning.

Question Title

* 1. 35-year-old man has 2 sisters with HFrEF. He had seen his PCP for dyspnea and was started on low dose furosemide with improvement of his symptoms. Today, his LVEF is 30% and he reports normal functional capacity. Cr is 1 mg/dL.

Which of the following is your best course of action?

A. Draw proBNP and start ACE-inhibitor if > 400 pg/ml

B. Do six-minute walk test and start ACE-inhibitor if walks < 400 meters

C. Draw HF gene panel and start ACE-inhibitor if mutation identified

D. Start ACE-inhibitor today

Question Title

* 2. 45-year-old AA female presents with 1 month of orthopnea and dyspnea while dressing. BP 85/60 mm Hg, HR 100. JVP 12 cm. 2+ edema. No CAD at catheterization. LVEF 20%, LVDd 7.5 cm. She remains on an ACEi used for 2 years for hypertension. Cr 2.5 mg/dL.

You were asked to see her in the hospital in consultation and you recommend:

A. Transplant evaluation

B. Add furosemide and then BBL when euvolemic

C. Add aldactone

D. LVAD evaluation

E. Add isordil 20 mg and hydralazine 37.5 mg tid

Question Title

* 3. A 75-year-old African American man had an anterior MI 5 years ago resulting in LVEF 30%. He was treated with maximal doses of lisinopril, carvedilol, statin, and aspirin. He developed symptomatic heart failure 2 months ago requiring hospitalization and was started on diuretics. Today in your office he remains NYHA class 2 but is compensated on examination with blood pressure 110/75 mm Hg. Cr is 1.8 mg/dL and K is 3.8.

Which therapy should you start now?

A. Digoxin

B. Isordil 20 mg/Hydralazine 37.5 mg tid

C. Spironolactone

D. Candesartan

E. Potassium supplementation

Question Title

* 4. 55-year-old white man with a nonischemic cardiomyopathy x 5 years moved to your city and seeks to establish care with you. NYHA class 2 symptoms. He was converted to candesartan from enalapril three years ago after an episode of angioedema. He is also on carvedilol 25 mg bid, spironolactone 25 mg, and furosemide 40 mg bid. He has an ICD. He is compensated on examination with HR 65 bpm and BP 128/75 mm Hg. LVEF 25% one month ago.

Which of the following would you recommend?

A. Re-challenge with ACE-inhibitor

B. Start sacubitril/valsartan and stop candesartan

C. Add digoxin

D. Add ivabradine

E. Continue current medical therapy

Question Title

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