Heart Failure EXERCISES. Ⅰ. True or false questions (mark for true question, mark for false question. If it is false, correct it.

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1 Heart Failure EXERCISES Ⅰ. True or false questions (mark for true question, mark for false question. If it is false, correct it. ) 1. Heart rate increase is a kind of economic compensation, which should lead to coronary arterial filling insufficient.( ) 2. Left heart failure results in pulmonary circulation congestion and pulmonary edema; right heart failure may lead to systemic circulation congestion and general edema.( ) 3. Low output heart failure is a common heart failure type.( ) 4. Aortic stenosis can increase the volume load of left ventricle.( ) 5. Hyperthyroidism can lead to low output heart failure.( ) Ⅱ.Multiple choice questions of type A 1. Which one of the following statements is the most consistent with the definition of heart failure?(c) A. Stroke volume is decreased

2 B. The volume of venous return is great than the volume of cardiac output C. Cardiac output can not meet body s requirement for metabolism D. Heart dysfunction results in congestion in pulmonary and systemic circulation E. A syndrome with pulmonary edema, hepatosplenomegaly and lower limbs edema 2. Which one of the following descriptions about high output heart failure is wrong?(e) A. Patient s cardiac output is lower than that of before heart failure occurrence B. Patient s cardiac output may be slightly higher than the normal volume C. Peripheral vessels of the patient are dilated D. The volume of venous return is increased in the patient

3 E. The difference of arterio venous oxygen content is increased in the patient 3.Which one the following is the most common disease for developing to the right ventricle concentric hypertrophy? A. Pulmonary arterial hypertension B. Severe anemia C. Mitral regurgitation D. Hypertension E. Aortic valves incompetence 4. The most significant change in heart failure is(b) A. Decreased blood pressure B. Absolutely or relatively decreased cardiac output C. Increased blood volume D. Decreased difference of arteriovenous oxygen content E. Decreased arterial partial pressure of oxygen 5. Which one of the following statements about compensation in cardiac insufficiency is correct? (C)

4 A. Increased heart rate is a slow compensation in chronic heart failure B. When heart rate reaches to 180/min, patient s cardiac output can be increased effectively C. Hypertrophy is most long persistent, economic and efficient compensation D. Concentric hypertrophy can develop to the eccentric hypertrophy. E. Myocardiogenic dilatation can elevate cardiac contractility by Frank Starling law 6.Which one of the following diseases can increase the pressure load of left ventricle?(b) A. Hyperthyroidism B. Hypertension C. Pulmonary hypertension D. Ventricular septal defect E. Myocarditis

5 7. In chronic right heart failure, which one of the following statements is incorrect?(a) A. Blood volume decreases B. Ejection fraction falls down C. Cardiac output reduces D. Rate of blood flow becomes slower E. Ventricular end diastolic pressure rises 8. Which one of the following diseases can result in excessive volum load of left atrium?(c) A. Hyperthyroidism B. Ventricular septal defect C. Mitral regurgitation D. Essential hypertension E. Pulmonary hypertension 9. Acute right heart failure can be caused by which one of the following diseases?(d) A. Essential hypertension B. Myocardial infraction C. Hyperthyroidism D. Pulmonary embolism

6 E. Aortic valve incompetence 10. The main pathogenesis of impaired energy utilization in excessive hypertrophic myocardium is(e) A. Decreased actin B. Decreased myosin C. Increased myosin D. Decreased ATPase E. Increased isoenzyme V 3 of myosin ATPase and decreased isoenzyme V 1 Ⅳ. Multiple choice questions of type X 1. Up infection can promote the development of heart failure, the mechanism of it is related to (A B C E) A. Fever increases body s metabolism B. Endotoxin inhibits heart function artery C. Increased heart rate reduces the blood flow of coronary D. Extra respiratory dysfunction

7 E. Oxygen consumption increases or oxygen supply decrease in myocardium 2. Which of the following statements are mechanisms for hyperthyroidism leading to heart failure? (B C) A. Speed the blood through increase the contractility of the myocardium B. Elevate body metabolic requirement C. Cardiac output can t match the requirement of body metabolic D. Cardiac output bellows the normal level E. Thyroxin increase the heart rate 3.The mechanisms of paroxysmal nocturnal dyspnea resulted from left heart failure may be(acde) A. When patient lies down, more blood returns to heart from his lower limbs. It makes pulmonary congestion and edema become more severe B. Frothy sputum blocks air tract

8 C. When patient lies down, his diaphragm is raised and vital capacity reduces obviously D. When patient goes to sleep, excitability of vague nerves is increased; it promotes the contraction of bronchi, diameter of bronchi becoming thinner E. Sensitivity of nervous reflection is depressed in sleep 4. Parameters for reflecting cardiac function include(bcd) A. Artery blood pressure B. Cardiac output C. Cardiac index D. Ejection fraction E. Blood flow rate 5. The main mechanisms of excitation contraction coupling dysfunction include(bde) A. Increased uptaking Ca 2+ by the sarcoplasmic reticulum B. Acidosis C. Hypokalemia D. Decreased concentration of norepinephrine in myocardium

9 E. Depressed activity of ATPase of the sarcoplasmic reticulum Ⅳ. Questions to be answered briefly detail Case: A-60-year-old man sustained a hypertension for 30 years. During the past 2 years, he becomes progressively more breathless on exertion. During the past 1 week, he can t sleep flat and resort to sleeping while sitting up. Chest X-ray revealed marked boot shape heart. And pulmonary venous congestion was observed. Questions: 1.Which side of the heart failure did the patient suffer from? Why? 2.Why the patient can t sleep flat? 3.What is the mechanism of this dyspnea? Answer:

10 1.Left side heart failure. Because of hypertension can evaluate the pressure load of left ventricle. It is orthopnea.increasing breathlessness on lying flat, called orthopnea.it mainly results from pulmonary congestion and edema due to the decreased pump function of left heart. The mechanisms of orthopnea are involved in: 1when patient lies down, his diaphragm is elevated, it leads to an obvious decrease of the vital capacity and impairment of ventilation; 2when patient lies down, more blood returns to heart from his lower limbs. It aggravates the pulmonary congestion and edema. So, the patient with severe heart failure can t lie at horizontal position, but is compelled to take a position of sitting.