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Review of Clinical Signs Review Questions

Clinical Diagnosis of Heart Failure

Bernard M. Karnath, MD

Choose the single best answer to each question.

1. A 63-year-old woman with newly diagnosed heart failure presents for a follow-up visit. She was diagnosed with heart failure during a hospitalization for dyspnea 1 month ago. Her medications include enalapril 10 mg daily, carvedilol 6.25 mg twice daily, and furosemide 20 mg twice daily. An echocardiogram performed during admission revealed a left ventricular ejection fraction of 30%. According to the patient’s current report, she is comfortable at rest, but ordinary physical activity results in symptoms. How should this patientŐs heart failure be classified using the New York Heart Association (NYHA) classification system?

  1. Class I
  2. Class II
  3. Class III
  4. Class IV
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2. A 55-year-old man with a 10-year-history of hypertension presents for routine follow-up. He is currently taking hydrochlorothiazide 25 mg daily and enalapril 10 mg daily. A routine interval electrocardiogram reveals left ventricular hypertrophy. Upon further review of systems the patient reports some mild dyspnea on exertion. What is the current stage for this patient’s heart failure based on the American College of Cardiology/American Heart Association staging system?

  1. Stage A
  2. Stage B
  3. Stage C
  4. Stage D
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3. A 59-year-old man who has been experiencing progressive dyspnea for the past 3 months presents for evaluation. Review of systems reveals that he has been experiencing dyspnea on exertion, orthopnea, and a nocturnal cough. Physical examination is significant for bilateral ankle edema. According to the Framingham criteria for congestive heart failure, which of this patientŐs findings is considered a major criterion?

  1. Bilateral ankle edema
  2. Dyspnea on exertion
  3. Nocturnal Cough
  4. Orthopnea
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4. A 60-year-woman presents to the emergency department for evaluation of a 3-week history of dyspnea. Her past medical history is significant for a 10-year history of both hypertension and diabetes. Social history is significant for a 30-pack year history of smoking. The physician is concerned about new-onset heart failure. In addition to a full history and physical examination, which of the following laboratory examinations would be most helpful in determining whether this patient’s dyspnea is due to heart failure?

  1. B-type natriuretic peptide
  2. Cardiac enzymes
  3. Chest radiograph
  4. D-dimer test
  5. Electrocardiogram
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