Deck 4: Cardiac Muscle Dysfunction and Failure

Question 1

Which of the following categories of cardiomyopathy is characterized by rapid ventricular emptying and high ejection fraction?

A)Dilated cardiomyopathy
B)Hypertrophic cardiomyopathy
C)Restrictive cardiomyopathy
D)Idiopathic cardiomyopathy

Answer 1

B
The characteristic findings of hypertrophic cardiomyopathy are rapid ventricular emptying and high ejection fraction,which are opposite of those found in dilated cardiomyopathy.

Question 2

Dilated cardiomyopathy is caused by which of the following factors?

A)Long-term alcohol abuse
B)Malalignment of myocardial fibers
C)Myocardial fibrosis
D)Abnormal sympathetic stimulation

Answer 2

A
Causes of dilated cardiomyopathy include long-term alcohol abuse,systemic hypertension,a variety of infections,cigarette smoking,pregnancy,and carnitine deficiency.

Question 3

Which of the following physiological changes would be considered true effects of aging as opposed to pathological processes?

A)Decreased distensibility of arteries
B)Development of coronary disease
C)Exposure to toxins such as cigarette smoking
D)Malnutrition

Answer 3

A
True effects of aging include increased systolic arterial pressure due to decreased distensibility of arteries and decreased aortic distensibility.

Question 4

Which of the following pathological conditions may lead to congestive heart failure (CHF)?

A)Hypertension
B)Renal insufficiency
C)Pulmonary embolism
D)All of the above

Question 5

Which of the following pathological conditions will result in scar formation with associated decreased contractility and reduced relaxation in the myocardial tissue?

A)Atrial fibrillation
B)Cardiomyopathy
C)Coronary bypass pump syndrome
D)Myocardial infarction

Question 6

Which of the following categories of cardiomyopathy is characterized by marked endocardial scarring of the ventricles with resulting impaired diastolic filling?

A)Dilated cardiomyopathy
B)Hypertrophic cardiomyopathy
C)Restrictive cardiomyopathy
D)Idiopathic cardiomyopathy

Question 7

Natriuretic peptides are released by cardiac muscle in response to increased stretch due to high filling or atrial pressures or cardiac dilation to produce which of the following affects?

A)Stimulation of rennin and aldosterone
B)Arterio- and venoconstriction
C)Reduced blood volume through natriuresis
D)Stimulation of vascular smooth muscle

Question 8

Pulmonary hypertension is defined by mean pulmonary arterial pressure (mPAP)and is considered abnormal in individuals with primary pulmonary hypertension recorded as:

A)>20 mm Hg.
B)>25 mm Hg.
C)>40 mm Hg.
D)>45 mm Hg.

Question 9

Increased arterial pressure that leads to left ventricular hypertrophy potentially causing CHF after a period of time describes which of the following?

A)Pulmonary embolism
B)Systemic hypertension
C)Pulmonary hypertension
D)Cardiomyopathy

Question 10

The resistance stroke volume encounters after it is ejected from the left ventricle is BEST defined as which of the following?

A)Preload
B)Ventricular end-diastolic volume
C)Pulmonary artery pressure
D)Afterload

Question 11

Mitral valve insufficiency frequently dilates which of the following heart chambers?

A)Left ventricle
B)Right ventricle
C)Left atrium
D)Right atrium

Question 12

Which of the following statements describes the reason energy expenditure is increased in persons with systemic hypertension?

A)Myocardial contractile fibers become overstretched
B)Increase in afterload
C)Increase in myocardial cell mass
D)Mismatch of cell mass to vasculature

Question 13

Which of the following is the BEST indirect method for a physical therapist to measure an increase in pulmonary capillary wedge pressure?

A)Pulse oximetry
B)Arterial blood gases
C)Auscultation
D)Pitting edema scale

Question 14

According to the Frank-Starling mechanism,an insignificant ventricular end-diastolic volume will result in which of the following changes in heart function?

A)Increase in stretch of the myocardium
B)Decrease in ventricular mechanical performance
C)No change in filling pressure
D)Increase in stroke volume producing elevated blood pressure

Question 15

Which of the following statements BEST describes the term diastolic heart failure?

A)Impaired contraction that produces an inefficient expulsion of blood
B)Loss of contracting myocardium as a result of anterior myocardial infarction
C)Inability of the ventricles to accept the blood ejected from the atria
D)Change in filling due to replacement of infracted area with distensible fibrous tissue

Question 16

In normal cardiac neurohumoral function,beta₂-adrenergic receptors facilitate which of the following physiological changes?

A)Increases heart rate and myocardial force of contraction.
B)Promotes vasodilation of capillary beds.
C)Activates the inhibitory G protein and inhibits adenylate cyclase.
D)Transmits stimulatory (Gs)or inhibitory (G1)signals to the catalytic unit.

Question 17

Which of the following pathophysiological changes potentially noted in patients with CHF results in the heart becoming insensitive to beta-adrenergic stimulation?

A)Excessive sympathetic nervous system stimulation
B)Decreased concentrations of norepinephrine
C)Decrease in Beta₁-adrenergic receptor density
D)Deactivation of adenylate cyclase

Question 18

An accumulation of fluid in the lungs along with hypoxemia and tachypnea BEST describes which of the following pulmonary edema stages?

A)Stage I
B)Stage II
C)Stage III
D)Stage IV

Question 19

Pulmonary capillary wedge pressure commonly monitored in patients in coronary care units closely approximates which of the following pressures?

A)Left ventricular filling pressure
B)Pulmonary artery pressure
C)Left atrial filling pressure
D)Right ventricular filling pressure

Question 20

Which of the following causes is MOST related to right heart failure?

A)Pulmonary embolus
B)Myocardial infarction
C)Hypertension
D)Aortic valve dysfunction

Question 21

A patient with cardiac disease resulting in marked limitation of physical activity,who is comfortable at rest,but reports fatigue,palpitation,dyspnea,or angina pain during less than ordinary activity,is considered to be in which of the following New York Heart Association functional classifications?

A)Class I
B)Class II
C)Class III
D)Class IV

Question 22

The intra-aortic balloon pump (IABP)improves oxygen delivery to the myocardium by which of the following mechanisms?

A)Increases intra-aortic pressure forcing blood into a retrograde direction.
B)Creates a diastolic attenuation.
C)Deflation of balloon decreases left ventricular afterload.
D)Creates a decrease in diastolic pressure.

Question 23

Liver dysfunction associated with congestive heart failure can be identified using which of the following laboratory values?

A)Elevated blood urea nitrogen
B)Abnormal AST
C)Elevated creatinine levels
D)Low hemoglobin and hematocrit

Question 24

Which of the following factors significantly predict survival in persons with congestive heart failure?

A)Diminished left ventricular ejection fraction
B)New York Heart Failure class II functional status
C)Episodes of hypotension
D)Exercise tachycardia

Question 25

The reduction of glucose metabolism in a patient with congestive heart failure is MOST likely due to impairment related to which of the following organs?

A)Skeletal muscle
B)Kidney
C)Liver
D)Pancreas

Question 26

A breathing pattern characterized by waxing and waning depths of respiration with recurring periods of apnea is termed which of the following?

A)Paroxysmal nocturnal dyspnea
B)Tachypnea
C)Cheyne-Stokes respiration
D)Orthopnea

Question 27

A patient with NYHA class II congestive heart failure is currently receiving physical therapy.Instruction about energy conservation will be included in the patient education session.Which of the following recommendations would be appropriate for this patient?

A)Stop and rest when you get tired.
B)Complete several tedious tasks at one time.
C)Alternate easy tasks with difficult tasks,plan for rest.
D)Keep the living environment setup the same.

Question 28

Which of the following medications prescribed for heart failure is noted to provide a positive inotropic effect evidenced by an increased left ventricular ejection fraction?

A)Diuretics
B)Dobutamine
C)Nitroglycerin
D)Topral

Question 29

Which of the following distances walked by a patient with congestive heart failure during a 6-minute walk test assists with determination of short- and long-term survival?

A)300 meters
B)350 meters
C)400 meters
D)450 meters

Question 30

A patient with congestive heart failure is being seen by a physical therapist for exercise progression.The patient is currently taking beta-blocker medication.Which of the following methods to monitor exercise intensity is MOST appropriate for this patient?

A)Heart rate response
B)Patient observation
C)Rating of perceived exertion
D)Blood pressure response

Question 31

Patients with anemia who have less reserve before their oxygen stores desaturate are indicative of what type of shift in the oxyhemoglobin curve?

A)Left
B)Right
C)More steep
D)More shallow

Question 32

Paroxysmal nocturnal dyspnea (PND)is defined as which of the following statements?

A)Breathlessness or air hunger
B)Sudden shortness of breath in sitting
C)Sudden shortness of breath in supine
D)Dyspnea due to fluid in the lower portions of the lungs

Question 33

A noncompliant left ventricle that occurs as blood passively fills a poorly relaxing ventricle during early diastole and is considered the hallmark of congestive heart failure describes which of the following heart sounds?

A)S1
B)S2
C)S3
D)S4