Heart Failure MCQs

Doxorubicin can be associated with cardiac failure, reduced left ventricular ejection fraction and tachyarrhythmias. Platinum based chemotherapies are associated with peripheral neuropathy, and bleomycin with interstitial pneumonitis and a specific skin lesion called 'flagellate dermatitis'. Drugs causing dilated cardiomyopathy Doxorubicin (Adriamycin) Trastuzumab (Herceptin) Tacrolimus Zidovudine Drugs like NSAIDs, Thiazolidinediones can cause fluid retention and thus worsen heart failure in patients with underlying disease. Reference : Harrison's Principles of Internal Medicine 21 st edition Page 737,1964

Following a myocardial infarction, patients with LV dysfunction benefit from taking β-Blockers and RAAS blockers. There is strong evidence supporting the use of aspirin and a statin post-MI. In the absence of anginal pain, prophylactic use of nitrates is not mandatory. Diuretics is indicated for patients with symptomatic heart failure and those with fluid overload. Reference: Harrison's Principles of Internal Medicine 21 st edition Page no: 2048-50

Answer is C (Constrictive pericarditis) Kussmaul's sign is classically described in association with Constrictive Pericarditis. Kussmaul's sign refers to paradoxical elevation of JVP/CVP during inspiration (In healthy persons venous pressure falls during inspiration because pressures in the right heart decrease as intrathoracic pressures fall) The Kussmaul's sign is classically described in association with Constrictive pericarditis. Kussmaul's sign is however also seen in association with Right Ventricular Infarction, Restrictive Cardiomyopathy, Pulmonary Embolism and Advanced Systolic Severe Heart Failure

Diuretics are useful in patients with heart failure and features of fluid overload though they don't confer mortality benefit. Beta blockers shown to have mortality benefit include carvedilol, metoprolol, bisoprolol. While administering ACE inhibitor and spironolactone, we need to be cautious about the risk of hyperkalemia. Reference : Harrison's Principles of Internal Medicine 21 st edition Page 1945-47

Revascularization is considered when: Progressive decline in GFR during treatment of systemic hypertension Failure to achieve adequate blood pressure control with optimal medical therapy(medical failure) Rapid or recurrent decline in the GFR in association with a reduction in systemic pressure Decline in the GFR during therapy with ACE inhibitors or ARBs Recurrent congestive heart failure in a patient in whom the adequacy of left ventricular function does not explain a cause Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch:278, Pg: 2090.

The patient has ankle oedema which is usually due to vasodilatation by calcium channel blockers . The preferred initial antihypertensive therapy for the elderly patient will be hydrochlorthiazide . ACE inhibitors are preferred for those patients with heart failure or diabetic nephropathy. β-blockers are preferred for post-myocardial infarction and ischemic heart disease. Reference: Harrison’s Principles of Internal Principles, 20 th edition, ch:271 pg:1901,1903

The patient has pulmonary renal syndrome, and among the given options, the diagnosis would fit Wegener's granulomatosis, which is commonly cANCA positive. In patients with vasculitis, approximately 90 percent of cytoplasmic ANCA are PR3-ANCA and approximately 90 percent of perinuclear ANCA are MPO-ANCA. Option A: Anti smooth muscle antibody is seen in autoimmune hepatitis Option B: Anti dsDNA antibody is a specific antibody of systemic lupus erythematosus Option D: Anti Mi-2 antibodies are found in patients of dermatomyositis Reference: Harrison's Principles of Internal Medicine, 21 st edition, Ch:314, Pg:2340.

In this particular patient, colchicine is the best option. In acute gout, either colchicine or NSAIDs can be used. However, asthma contraindicates NSAIDs. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 372, Pg: 2865