ISHNE Heart Failure World-Wide Internet Symposium
 
CME Testing

Questions corresponding to lecture "Electromechanical Therapy. A historical perspective of device therapy in the failing heart", by Dr. Corbisiere.

SECTION I
1) A patient with non-ischemic cardiomyopathy, an EF of 33%, and Class I heart failure. This patient should:
1.0) Don't know.
1.A) Have an ICD based on SCD HeFT data
1.B) Have an ICD based on MADIT II
1.C) Have an ICD based on COMPANION
1.D) Not have an ICD placed
2) All of the following are important considerations in a patient with CRT therapy who is non-responsive to therapy:
2.0) Don't know.
2.A) Measurement of dyssynchrony including inter vs. intraventricular dyssynchrony
2.B) AV and VV timing
2.C) The base rate
2.D) All of them
3) What percentage of patients respond to CRT therapy
3.0) Don't know.
3.A) 99 %
3.B) 83 %
3.C) 66 %
3.D) 50 %

Questions corresponding to lecture "Role of the AV Interval in DDD Pacing: Insights into Programming with Respect to Ventricular Function when AV Nodal Conduction is Intact", by Dr. Levine.

4) If the indication for pacing is symptomatic sinus node dysfunction in a 68 year old patient with moderate first degree AV block (PR interval > 300 ms), a normal ventricular activation sequence and normal myocardial function at the time of implant, optimal ventricular performance would best be achieved by Implantation of a DDD pacemaker and programming the mode to AAI or its equivalent (extremely long AV delay, AV/PV hysteresis algorithm or one of the AAI to DDD special algorithms)
4.0) Don't know.
4.A) Implantation of a DDD pacemaker and careful assessment of hemodynamics to identify the optimal AV delay.
4.B) Implantation of a biventricular CRT system
4.C) Implantation of a single chamber atrial pacemaker
5) If the PR (atrial sensed - ventricular sensed) interval as measured from a surface ECG is normal with the patient at rest, the AR (atrial paced - ventricular sensed) interval will also be normal and it will be safe to program the pacemaker to the equivalent of the AAIR mode.
5.0) Don't know.
5.A) True
5.B) False

Questions corresponding to lecture "Cardiac sympathetic nerve terminal function in congestive heart failure", by Dr. Liang

SECTION II
6) The inotropic effects of intravenous dobutamine are diminished in patients with chronic heart failure, primarily because of one of the followings:
6.0) Don't know.
6.A) Decrease of the number of myocardial BETA-adrenergic receptors
6.B) Depletion of cardiac tissue norepinephrine
6.C) Increased washout of dobutamine
6.D) Reduction of norepinephrine transporter density
7) Carvedilol is a BETA- and ALPHA-adrenergic receptor blocker. It has been shown to produce the following beneficial effects in patients with chronic heart failure:
7.0) Don't know.
7.A) Increase of left ventricular ejection fraction
7.B) Improvement in 123I-metaiodobenzylguanidine (MIBG) uptake and washout patterns
7.C) Reduction of mortality and cardiac morbidity
7.D) All of the above
8) One of the followings is not true concerning myocardial norepinephrine uptake:
8.0) Don't know.
8.A) Inotropic response to tyramine is diminished in heart failure because of reduced cardiac norepinephrine stores
8.B) ACE inhibitors, ß-blockers and spironolactone all have been shown to improve myocardial norepinephrine uptake in heart failure
8.C) Myocardial norepinephrine uptake is reduced in heart failure, probably because of decrease of norepinephrine storage in the heart
8.D) Desipramine reduces cardiac norepinephrine uptake activity, but may lead to improvement of cardiac sympathetic innervation in heart failure

Questions corresponding to lecture "Cardiac Resynchronization Therapy for Heart Failure.", by Dr. Styperek.

9) Indication for BiVentricular pacing include:
9.0) Don't know.
9.A) Moderate to severe heart failure (NYHA Class III/IV)
9.B) QRS >= 130 ms
9.C) LV ejection fraction <= 35%
9.D) All of the above
10) ICD implant is indicated in the following:
10.0) Don't know.
10.A) Patients with left ventricular ejection fraction of less than or equal to 30% 7 days post myocardial infarction and 7 days post coronary artery revascularization surgery.
10.B) Patients with left ventricular ejection fraction of less than or equal to 40% at least 1 month post myocardial infarction and 3 months post coronary artery revascularization surgery.
10.C) Patients with left ventricular ejection fraction of less than or equal to 30% at least 1 month post myocardial infarction and 3 months post coronary artery revascularization surgery.
10.D) Patients with normal left ventricular ejection fraction at least 1 month post myocardial infarction and 3 months post coronary artery revascularization surgery.
SECTION III
11) The following has/have been found to be independent predictors of mortality:
11.0) Don't know.
11.A) Creatinine
11.B) LV EF
11.C) QRS duration
11.D) All of the above

Questions corresponding to lecture "The Management of Heart Failure after Biventricular Pacing", by Dr. Aranda.

12) A 45-year-old patient with nonischemic cardiomyopathy, ejection fraction 20%, and QRS duration 130 msec receives a biventricular pacer. He is on lisinopril 10 mg po qd, carvedilol 6.35 mg po bid, and Lasix 60 mg po bid. He returns to clinic 1 month after implant with no improvement of symptoms. Physical exam shows heart rate 80 beats per minute, blood pressure 130/70, no JVD, lungs clear, regular heart rhythm with S2 present, and no edema. Laboratory results show BUN 80 and creatinine 1.7. The following step should be performed:
12.0) Don't know.
12.A) Check echocardiogram for dyssynchrony.
12.B) Reduce or discontinue the ACE inhibitor.
12.C) Reduce of discontinue diuretics.
12.D) Check for proper pacemaker function.
13) The same patient in question 1 (above) receives an intervention and comes back to clinic 1 month later. He feels better with more exercise tolerance. Physical exam shows heart rate 70 beats per minute, blood pressure 130/70m and no evidence of volume overload. The following statement is appropriate:
13.0) Don't know.
13.A) Continue to observe because the patient feels well.
13.B) Increase dose of Carvedilol to 12.5 mg po bid.
13.C) Check and optimize A-V delay.
13.D) Check echocardiogram for improvement in ejection fraction.

Questions corresponding to lecture "ICD and CRT in Heart Failure.", by Dr. Moss.

14) Reduction in risk of all-cause mortality in Madit II trial was
14.0) Don't know.
14.A) 15%
14.B) 20%
14.C) 31%
14.D) 50%
15) Madit CRT was designed to answer the question of the safety and efficacy of CRT
15.0) Don't know.
15.A) for the prevention of heart failure
15.B) for the treatment of heart failure
15.C) with better results than ICD
15.D) comparing pharmacological therapies in patients with CRT

Questions corresponding to lecture "Prediction of Response to Cardiac Resynchronization Therapy", by Drs. Francis, Roy and John.

SECTION IV
16) All the following parameters are echocardiographic evidence of intraventricular dysynchrony except
16.0) Don't know.
16.A) Aortic pre-ejection time (> 140 ms)
16.B) Difference between aortic and pulmonary pre-ejection periods > 40 ms
16.C) Septal-to-posterior wall motion delay > 130 ms
16.D) TDI dispersion of ventricular contraction > 40 ms
17) ECG evidence of LBBB in patients with symptomatic heart failure is seen in
17.0) Don't know.
17.A) 0-60%
17.B) 0-50%
17.C) 0-40%
17.D) 0-30%
18) All the following are true EXCEPT
18.0) Don't know.
18.A) CRT improves symptoms and reduces all-cause mortality
18.B) About 30% of patients do not improve with CRT with standard criteria
18.C) Patients with RBBB does not show improvement with CRT
18.D) Tracking of myocardial deformation with strain rate imaging has a higher time resolution than MRI

Questions corresponding to lecture "The interaction of Anemia, Heart Failure and Renal Failure - The Cardio Renal-Anemia Syndrome", by Drs. Wexler, Silverberg and Tzivoni.

19) Anemia in heart failure is usually caused by
19.0) Don't know.
19.A) Associated chronic renal failure from reduced renal blood flow
19.B) Cytokines which are high in CHF and interfere with erythropoietin and iron metabolism
19.C) ACE inhibitors and ARBs which depress the bone marrow
19.D) Aspirin which can cause gi bleeding
19.E) all of them
20) Anemia in heart failure is associated with
20.0) Don't know.
20.A) an increase in mortality, morbidity and hospitalization
20.B) increase cardiac and patient function
20.C) less need for diuretics
20.D) less need for statins
SECTION V
21) Anemia in heart failure can be successfully treated with
21.0) Don't know.
21.A) Subcutaneous Erythropoietin
21.B) Oral or IV iron
21.C) A combination of A and B
21.D) Vitamin B12
21.E) folic acid

Questions corresponding to lecture "When to Consider Heart Transplant", by Dr. Jessup.

22) Which of the following conditions always represent a contraindication to heart transplant?
22.0) Don't know.
22.A) diabetes mellitus requiring insulin
22.B) non-Hodgkins lymphoma in remission for 5 years
22.C) active Hepatitis C
22.D) endocarditis with vegetation.
23) The goal(s) of heart transplant is(are): (choose one best answer)
23.0) Don't know.
23.A) to prolong life
23.B) to improve quality of life
23.C) to improve quality of life and duration of life
23.D) to provide a cost-effective treatment for end-stage heart failure
24) Patients with idiopathic cardiomyopathy waiting for heart transplant should not be considered for ICDs (implanted cardio-defibrillators).
24.0) Don't know.
24.A) true
24.B) false

Questions corresponding to lecture "Implantable Cardioverter Defibrillator Therapy in MADIT II Patients with Signs and Symptoms of Heart Failure", by Dr. Zareba.

25) Results of the MADIT II changed practice of medicine regarding prevention of mortality in high-risk patients. What type of patients qualify for ICD following MADIT II indications?
25.0) Don't know.
25.A) nonischemic dilated cardiomyopathy patients with EF<=35% and inducible ventricular tachycardia
25.B) postinfarction patients with EF<=30% and inducible ventricular tachycardia
25.C) postinfarction patients with EF<=30% regardless of inducibility
25.D) nonishcemic and ischemic cardiomyopathy patients with EF<=35% regardless of inducibility
SECTION VI
26) SCD-HeFT trial showed that:
26.0) Don't know.
26.A) amiodarone is useful in secondary prevention of mortality
26.B) amiodarone is not different than placebo in preventing mortality
26.C) amiodarone is useful in primary prevention of mortality
26.D) amiodarone is useful in preventing recurrences of atrial fibrillation
27) When considering MADIT II type patients what parameter could be used to differentiate patients with low versus high benefit from an ICD:
27.0) Don't know.
27.A) NYHA class
27.B) Ejection fraction
27.C) BUN
27.D) one of the above
28) Hazard ratio for mortality in MADIT II patients in NYHA class III is:
28.0) Don't know.
28.A) 0.89 = 11% reduction in mortality
28.B) 0.65 = 35% reduction in mortality
28.C) 0.69 = 31% reduction in mortality
28.D) 0.72 = 28% reduction in mortality

Questions corresponding to lecture "Heart Failure: Atrial Fibrillation", by Dr. Steinberg.

29) Which is not a characteristic of atrial electrophysiology in heart failure?
29.0) Don't know.
29.A) Slow conduction
29.B) Increased automaticity
29.C) Lengthened refractory periods
29.D) Abnormal sinus node function
30) Which may contribute to the adverse effect of AF on prognosis in heart failure?
30.0) Don't know.
30.A) Rapid ventricular rates
30.B) Irregularly irregular pattern
30.C) Hypercoagulable state
30.D) All of the above
SECTION VII
31) Why would resynchronization therapy fail in patients with AF?
31.0) Don't know.
31.A) Complete biventricular capture
31.B) Excellent rate control
31.C) Frequent fusion and pseudofusion
31.D) Amiodarone therapy

Questions corresponding to lecture "Creation of a New Bioartificial Myocardium: Dream or Reality?", by Dr. Chachques.

32) The goal of cell transplantation is all of the following, EXCEPT:
32.0) Don't know.
32.A) to grow of new muscle fibers;
32.B) to develop angiogenesis in the damaged myocardium;
32.C) to reverse the postischemic remodeling process of the ventricular chambers;
32.D) to increase neurohormonal activation.
33) Which types of stem cells are actually transplanted into the damaged myocardium:
33.0) Don't know.
33.A) peripheral blood stem cells;
33.B) vascular endothelial cells;
33.C) mesothelial cells;
33.D) all of them.
34) Which types of collagen fibers are there in the normal adult heart:
34.0) Don't know.
34.A) types I and II;
34.B) types II and III;
34.C) types I and III;
34.D) types I, II and III.

Questions corresponding to lecture "Origin and Determinants of ANF and BNP Production by the Heart under Normal and Pathophysiological Conditions", by Dr. de Bold.

35) The general functions of natriuretic peptides are all of the following, EXCEPT:
35.0) Don't know.
35.A) the stimulation of ventricular hypertrophy;
35.B) the modulation of cardiac preload and afterload;
35.C) the regulation of water and electrolyte balance;
35.D) effect on cardiovascular growth.
SECTION VIII
36) The difference in mass between the atrial and ventricular chambers is approximately:
36.0) Don't know.
36.A) 1:10;
36.B) 1:5;
36.C) 1:3;
36.D) 1:7.
37) Which of the following expression is FALSE:
37.0) Don't know.
37.A) in both, atria and ventricles, ANF is more abundant than BNP;
37.B) BNP might be a ventricular hormone;
37.C) not only BNP but also ANF is present in the ventricles;
37.D) all of them.

Questions corresponding to lecture "Controversies in the pharmacologic therapy of patients with heart failure", by Dr. Pitt.

38) A retrospective analysis of the DIG trial suggests that the beneficial effect on CV mortality could be achieved with the serum digoxin level between:
38.0) Don't know.
38.A) 0.1 and 0.5 micro grams /ml;
38.B) 0.5 and 1.0 micro grams /ml;
38.C) 1.0 and 1.5 micro grams /ml;
38.D) 1.5 and 2.0 micro grams /ml.
39) In Val-Heft, the addition of the ARB valsartan to patients treated with an ACE-I and a BB has demonstrated:
39.0) Don't know.
39.A) a significant reduction in CV mortality;
39.B) a significant reduction in hospitalization for HF;
39.C) a significant reductions in CV mortality and hospitalization for HF;
39.D) non of them.
40) In RALES trial the reduction in hospitalization for HF was a:
40.0) Don't know.
40.A) 25%;
40.B) 30%;
40.C) 35%;
40.D) 40%.
SECTION IX
41) The mineralo-corticoid receptor, when stimulated, have been shown to have a number of effects, EXCEPT:
41.0) Don't know.
41.A) myocardial and vascular hypertrophy and fibrosis;
41.B) inhibition of fibrinolysis;
41.C) decrease in central sympathetic activity;
41.D) endothelial dysfunction.

Questions corresponding to lecture "Heart rate turbulence in patients with nonishhemic heart failure", by Drs. Makarov, Komoliatova, Gorlitskaya, Tutelman and Kalachanova.

42) In the case of complete vago-sympathetic block, average HR in comparison to onset HR:
42.0) Don't know.
42.A) It does not vary;
42.B) It increases;
42.C) It decreases;
42.D) Its reaction depends on HR severity.
43) The analysis of non-sinus rhythm variability is used for patients with:
43.0) Don't know.
43.A) Ventricular bigeminy;
43.B) Complete AV block;
43.C) Atrial fibrillation;
43.D) Sinus node disease.
44) The entrance criteria for extrasystoles in heart rate turbulence (HRT) analysis are:
44.0) Don't know.
44.A) Presence of at least 20 sinus RR intervals before and after the extrasystole;
44.B) Minimal value of precocity index is 20%;
44.C) RR duration no less than 300 ms and more than 2000 ms;
44.D) All of the above answers are correct.

Questions corresponding to lecture "Use of the Method of Heart Rate Variability Analysis for the Assessment of Functional-Clinical State of Patients with Chronic HF, its Prognosis and the Effectiveness of the Standard Treatment.", by Drs. Vasyuk, Yuschuk, Shupenina and Serova.

45) While HR progresses, circadian index values (ratio between day and night HR average):
45.0) Don't know.
45.A) Increase >1.5;
45.B) Decrease <1.2;
45.C) Do not change;
45.D) Vary differently.
SECTION X
46) The indicator that best characterizes sympathetic influences on the heart rhythm is:
46.0) Don't know.
46.A) HF;
46.B) LF;
46.C) LF/HF;
46.D) VLF.
47) What drugs, used for treating HR, influence on HRV indicators?
47.0) Don't know.
47.A) ACEI;
47.B) Digitalis;
47.C) BETA-blockers;
47.D) All above

Questions corresponding to lecture "The Genetic Causes of Heart Failure. A focus on sudden death: from the molecular mechanisms to clinical approach.", by Drs. Pérez Riera, Schapachnik and Dubner.

48) Arrhythmogenic right ventricular dysplasia is an entity:
48.0) Don't know.
48.A) Of high prevalence in the Veneto region
48.B) Of high prevalence in the Greek island of Naxos
48.C) It is the first cause of death in young athletes in Europe
48.D) All of the above are correct.
49) In dilated cardiomyopathy, one of the following answers is not true:
49.0) Don't know.
49.A) It is a disease of the cytoskeleton or cytoskeletalopathy
49.B) It is considered a disease of "force transmission"
49.C) The female gender is more affected
49.D) It is the third most common cause of heart failure.
50) The following entities may cause restrictive cardiomyopathy, except:
50.0) Don't know.
50.A) Non-compacted myocardium
50.B) Hemochromatosis
50.C) Scleroderma
50.D) Pompe's disease.
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