Fast Five Quiz: Test Your Knowledge on Key Aspects of Heart Failure

Yasmine S. Ali, MD, MSCI


February 07, 2020

Because of increased myocardial oxygen consumption and demand beyond a critical level, the following high-output states can precipitate the clinical presentation of heart failure:

  • Profound anemia

  • Thyrotoxicosis

  • Myxedema

  • Paget disease of bone

  • Albright syndrome

  • Multiple myeloma

  • Glomerulonephritis

  • Cor pulmonale

  • Polycythemia vera

  • Obesity

  • Carcinoid syndrome

  • Pregnancy

  • Nutritional deficiencies (eg, thiamine deficiency, beriberi)

The most common cause of decompensation in a previously compensated patient with heart failure is inappropriate reduction in the intensity of treatment, such as dietary sodium restriction, physical activity reduction, or drug regimen reduction. Uncontrolled hypertension is the second most common cause of decompensation, followed closely by cardiac arrhythmias (most commonly, atrial fibrillation).

Underlying causes of systolic heart failure include the following:

  • Coronary artery disease

  • Diabetes

  • Hypertension

  • Valvular heart disease (stenosis or regurgitant lesions)

  • Arrhythmia (supraventricular or ventricular)

  • Infections and inflammation (myocarditis)

  • Peripartum cardiomyopathy

  • Congenital heart disease

  • Drugs (either recreational, such as alcohol and cocaine, or therapeutic drugs with cardiac side effects, such as doxorubicin)

  • Idiopathic cardiomyopathy

  • Rare conditions (endocrine abnormalities, rheumatologic disease, neuromuscular conditions)

Underlying causes of diastolic heart failure include the following:

  • Coronary artery disease

  • Diabetes

  • Hypertension

  • Valvular heart disease (aortic stenosis)

  • Hypertrophic cardiomyopathy

  • Restrictive cardiomyopathy (amyloidosis, sarcoidosis)

  • Constrictive pericarditis

  • Increasing age

Underlying causes of acute heart failure include the following:

  • Acute valvular (mitral or aortic) regurgitation

  • MI

  • Myocarditis

  • Arrhythmia

  • Drugs (eg, cocaine, calcium channel blockers, or beta-blocker overdose)

  • Sepsis

Underlying causes of high-output heart failure include the following:

  • Anemia

  • Systemic arteriovenous fistulas

  • Hyperthyroidism

  • Beriberi heart disease

  • Paget disease of bone

  • Albright syndrome (fibrous dysplasia)

  • Multiple myeloma

  • Pregnancy

  • Glomerulonephritis

  • Polycythemia vera

  • Carcinoid syndrome

For more on the etiology of heart failure, read here.


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