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Chapter 5: Chronic Heart Failure

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JB is a 45-year-old man with cardiomyopathy (LVEF 35%) following an acute MI. Immediately following his MI, he developed signs and symptoms of HF including shortness of breath (SOB) at rest. Which of the following best characterizes JB’s current ACC/AHA HF stage and New York Heart Association (NYHA) class?

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a. Stage A, NYHA class not applicable

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b. Stage B, NYHA class I

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c. Stage C, NYHA class II

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d. Stage C, NYHA class IV

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Answer d is correct. JB meets the criteria for stage C. Patients such as JB who are stage C have developed signs and/or symptoms of heart failure. Additionally, JB has symptoms as rest; therefore, he is NYHA class IV.

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Answers a, b, and c are incorrect. Answer a-c are incorrect because JB has symptoms at rest and has had a myocardial infarction. Patients who are stage A are at risk for developing left ventricular dysfunction and heart failure (eg, due to hypertension, coronary artery disease). Patients who are stage B have developed structural heart disease but have not developed signs and symptoms of heart failure. The NYHA classification system categorizes patients as class I if they are relatively asymptomatic and physical activity is not limited by the heart failure disease process. Patients who are NYHA classes II and III are symptomatic with minimal and moderate physical activity, respectively.

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Which of the following is the best predictor of fluid status and should be monitored daily by all HF patients?

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a. Fatigue

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b. Shortness of breath

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c. Weight change

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d. Lower extremity edema

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Answer c is correct. Weight gain is the best predictor of fluid status since weight change often precedes overt HF signs and symptoms.

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Answer a is incorrect. Vague symptoms of fatigue may be common in HF patients, but these symptoms will not predict fluid status.

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Answers b and d are incorrect. Patients with fluid overload may present with signs and symptoms of pulmonary congestion such as shortness of breath (Answer b) or peripheral congestion such as lower extremity edema (Answer d). While these symptoms need to be monitored, they do not predict fluid status like weight change. Monitoring weight change daily can allow for an intervention (eg, increase in diuretic dose) to prevent pulmonary congestion.

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Which of the following laboratory values may be helpful in differentiating HF from other disease states that cause similar symptoms? Select ...

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