Pre-Test: Session 1 - Chronic Heart Failure Session 1 of 2017 Comprehensive Heart Failure Update & Review Question Title * 1. MM is a 65 yo male with stable NYHA class III HF (LVEF 30%) and a resting HR 65 bmp. He is currently on metoprolol succinate 200 mg daily, lisinopril 20 mg daily, and eplerenone 50 mg daily. Based on the 2016/2017 ACC/AHA/HFSA guidelines recommendations, what should be done to optimize his HF treatment to further reduce morbidity and mortality? A. Add ivabradine with a starting dose of 5 mg twice daily B. Switch lisinopril to irbesartan 300 mg daily C. Switch lisinopril to sacubitril/valsartan 49mg/51mg twice daily D. Nothing, he is already receiving optimal therapies Question Title * 2. LS is a 60 yo female with stable NYHA class II HF (LVEF 30%), sinus rhythm, SBP 120 mm Hg, and a resting heart rate 78 beats per minute. She is currently on maximum tolerated dose metoprolol succinate 200 mg daily, sacubitril/valsartan 97/103 mg twice daily, and eplerenone 50 mg daily. Based on the 2016/2017 ACC/AHA/HFSA guidelines recommendations, what can be done to further optimize her HF treatment and reduce the risk of heart failure hospitalization? A. Add ivabradine with a starting dose of 5 mg twice daily B. Add nifedipine 5 mg daily C. Switch sacubitril/valsartan to enalapril 20 mg daily D. Nothing, she is already receiving optimal therapies Question Title * 3. Which of the following BEST describes the effect of ivabradine in SHIFT? A. Reduced the relative risk of CV Death. B. Reduced the relative risk of hospitalizations for worsening HF. C. Increased the relative risk of hospitalization for worsening HF or CV death. D. No differences were seen on outcomes compared to standard of care. Question Title * 4. Which of the following BEST describes the recommended use of ivabradine in the 2017 ACC/AHA/HFSA heart failure guidelines? A. Strong recommendation with more than 1 high quality randomized clinical trials (Class I LOE A) B. Moderate recommendation with 1 or more randomized clinical trials (Class IIa LOE B-R) C. Moderate recommendation with 1 or more well-designed non randomized clinical trials (Class IIa LOE B-NR) D. Potential for harm and is not recommended (Class III) Question Title * 5. Omecamtiv-mercabil is: A. a calcium sensitizing agent B. a beta-agonist C. a myosin activator D. combined alfa and beta agonist Question Title * 6. SGLT2 is responsible for the absorption of which percentage of glucose filtered by the kidney? A. > 90% B. 20%-40% C. >40%-60% D. > 60%-80% Question Title * 7. A Ferritin of 100-299 mcg/L combined with a transferring saturation <20% indicates: A. Absolute Iron deficiency B. Normal Iron Stores C. Anemia of chronic disease D. Functional Iron Deficiency Question Title * 8. The acronym S.A.R.C.F. stands for: A. Sarcomere Advanced Research in Cardiac Function B. Strength, Assistance in walking, Rise from chair, Climbing stairs, Falls C. Sadness, Anxiety, Rage, Confrontation, Frustration Question Title * 9. Which of the following patient presentations are consistent with a diagnosis of HFpEF? A. 50 y/o M. PMHx of IV drug abuse. Presents with symptoms of DOE, PND, orthopnea, fatigue, early satiety, bloating. EKG is sinus tachycardia. Echo: left ventricular enlargement, left atrial enlargement, diastolic dysfunction, PASP = 40mmHg, E/e’ = 19, EF = 35%. BNP = 2400. B. 70 y/o F. PMHx of HTN. Asymptomatic and can go up flight of stairs in her home without decreased tolerance for this activity or increased fatigue. EKG is sinus rhythm. Echo: mild septal LVH, normal LV chamber size, mild LAE, diastolic dysfunction, PASP=10mmHg, E/e’=8, EF=65%. BNP=25. C. 69 y/o F. PMHx of afib, HTN, CAD, obesity. Presents with symptoms of CP, DOE, fatigue. EKG: afib, HR = 95 bpm, diffuse NSSTW changes. Echo: left ventricular enlargement, left atrial enlargement, diastolic dysfunction, hypokinetic inferior wall, PASP=40mmHg, E/e’=15, EF=51%. Troponin = 22, BNP = 550. D. 75 y/o F. PMHx of HTN, mild CKD. DOE, LEE, fatigue. EKG: SR. Echo: normal LV chamber, mild LVH, left atrial enlargement, diastolic dysfunction, PASP = 20mmHg, E/e’=15, EF=60%. BNP = 300. E. 65 y/o M. PMHx of pacemaker. Presents with symptoms of dizziness, fatigue, DOE. EKG: intermittently paced rhythm, underlying rhythm is low voltage and sinus bradycardia. Echo: severe left and right atrial enlargement, LVH, normal to small LV chamber size, diastolic dysfunction, E/e’=22, EF=51% Question Title * 10. Based on the study, Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) Trial, mineralocorticoid receptor antagonists are suggested in patients with HFpEF due to the following findings: A. The composite primary outcome of CVD, aborted cardiac arrest or hospitalization for HF was superior for spironolactone as compared with the placebo group. B. Hospitalization for HF was less frequent in the spironolactone group compared with the placebo group. C. Total deaths were lower in the spironolactone group. D. Spironolactone was non-inferior to the ACE inhibitor, Enalapril. Question Title * 11. Please provide your first and last name.Pre-test questions will not be scored, your name is required solely to confirm completion. First Name & Last Name Done
