Heart failure

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Heart failure




Heart failure


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USMLE® Step 1 questions

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High Yield Notes

9 pages


Heart failure

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USMLE® Step 1 style questions USMLE

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 76-year-old woman presents to the emergency department for evaluation of increased lower extremity swelling and shortness of breath. The patient has had progressive lower extremity swelling over the past several weeks to the point where she can no longer fit into her normal shoe size. In addition, she can no longer walk half a city block before becoming short of breath. Past medical history includes hypertension, diabetes, and a deep vein thrombosis after a long flight ten years ago. The patient has been smoking one pack of cigarettes per day for thirty-five years. Temperature is 36.1°C (97.0°F), pulse is 78/min, respirations are 16/min, blood pressure is 156/92 mmHg, and O2 is 90% on room air. Physical examination demonstrates a loud P2, jugular venous distension, faint bilateral end-expiratory wheezing, and 2+ pitting edema in the bilateral lower extremities. A chest X-ray is obtained and shown below. Which of the following best describes the pathophysiology of this patient’s lower extremity findings?  

Image reproduced from Wikimedia Commons 

External References

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ACE inhibitors p. 634

heart failure p. 318

Angiotensin II receptor blockers p. 634

heart failure p. 318

β -blockers p. 247

heart failure p. 318

Cardiomyopathy p. 317

heart failure with p. 318


heart failure and p. 318


heart failure p. 318


heart failure p. 318


heart failure and p. 318


heart failure and p. 318

Heart failure p. 318

ACE inhibitors for p. 634

acromegaly p. 343

acute tubular necrosis with p. 626

amiodarone p. 329

angiotensin II receptor blockers p. 634

aortic regurgitation as precursor p. 298

associations p. 730

atrial septal defect p. 305

β -blockers for p. 247, 329

B-type natriuretic peptide in p. 301

calcium channel blockers p. 363

carcinoid syndrome p. 592

cardiac glycosides for p. NaN

chronic ischemic heart disease p. 310

contractility in p. 292

diabetic ketoacidosis p. 357

disopyramide p. 328

dobutamine for p. 243

dopamine for p. 243

Ebstein anomaly p. 304

ejection fraction in p. 292

ESR in p. 212

fludrocortisone and p. 362

hydralazine for p. 323

hypertension p. 306

hypertension treatment in p. 323

hypertensive emergency and p. 306

jugular venous pulse in p. 295

loop diuretics for p. 632

MI p. 311

Paget disease of bone p. 473

pleural effusion p. 705

potassium-sparing diuretics p. 633

pulmonary hypertension p. 703

pulse pressure in p. 292

readmissions with p. 277

renal failure causing p. 626

shock caused by p. 323

in sleep apnea p. 703

systolic vs diastolic p. 292

thiazides for p. 633

ventricular septal defect p. 305

Hydralazine p. 325

heart failure p. 318

Hypertension p. 306

heart failure p. 323

Loop diuretics p. 632

for heart failure p. 318

Myocardial infarction (MI) p. 310

heart failure caused by p. 318

Peripheral edema

heart failure p. 318

Pulmonary edema

heart failure p. 318

Spironolactone p. 633, 669, 679, 682

for heart failure p. 318

Thiazide diuretics

heart failure p. 318


Content Reviewers

Heart failure’s used to describe a point at which the heart can’t supply enough blood to meet the body’s demands.

This can happen in two ways, either the heart’s ventricles can’t pump blood hard enough during systole, called systolic heart failure, or not enough blood fills into the ventricles during diastole, called diastolic heart failure.

In both cases, blood backs up into the lungs, causing congestion or fluid buildup, which is why it’s also often known as congestive heart failure, or just CHF.

Congestive heart failure affects millions of people around the world and since it means that the body’s needs are not being met, it can ultimately lead to death.

Part of the reason why so many people are affected by heart failure, is that there are a wide variety of heart diseases like ischemia and valvular disease that can impair the heart’s ability to pump out blood and—over time—can ultimately cause the heart to fail.

Alright, first up is systolic heart failure, kind of a mathematical way to think this one is that the heart needs to squeeze out a certain volume of blood each minute, called cardiac output, which can be rephrased as the heart rate (or the number of beats in a minute) multiplied by the stroke volume (the volume of blood squeezed out with each heart beat).

The heart rate is pretty intuitive, but the stroke volume’s a little tricky.

For example, in an adult the heart might beat 70 times per minute and the the left ventricle might squeeze out 70ml per beat, so 70 x 70 equals a cardiac output of 4900 ml per minute, which is almost 5 liters per minute.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "The Impact of Frailty and Comorbidities on Heart Failure Outcomes" Cardiac Failure Review (2022)
  6. "Effects of Digoxin in Heart Failure (HF) With Reduced Ejection Fraction (EF)" Cureus (2022)
  7. "Advanced heart failure: guideline‐directed medical therapy, diuretics, inotropes, and palliative care" ESC Heart Failure (2022)

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