2024 The Medical Necessity Series Part I: Chest Pain/AMI, Heart Failure, Atrial Fibrillation (35) – Post Test

1. Use this case presentation to answer the following question:

You have “patient HF” who has been experiencing worsening shortness of breath, bilateral edema in both legs, and an increase in his weight of about 10 pounds over the last 1-2 weeks. You have not seen him in 2 years.  There is no known history of HTN, DM, or CAD.  He has hyperlipidemia (last LDL 151) but he doesn’t take any medications (the Rx “ran out”).  His BMI is 33.  No history of cardiac or lung disease is noted but on physical exam you note 2+ pitting edema, elevated JVP and rales. Vitals are stable (146/89; HR 85 and regular) with RA saturation of 94% without accessory muscle use.  You pursue further workup with chest x-ray, echocardiogram, and labs to determine the cause of his symptoms.  You suggest a one-week follow-up for BP reck and to discuss lab findings.

The results of the “patient HF’s” workup reveal cardiomegaly on chest x-ray and an EF of 36% on echocardiogram with left ventricular hypokinesis. His eGFR is 50, electrolytes are normal. Glucose (fasting) is 131.  Based on these findings, what diagnosis would you conclude is the cause of his symptoms?

2. Use this case presentation to answer the following question:

You have “patient HF” who has been experiencing worsening shortness of breath, bilateral edema in both legs, and an increase in his weight of about 10 pounds over the last 1-2 weeks. You have not seen him in 2 years.  There is no known history of HTN, DM, or CAD.  He has hyperlipidemia (last LDL 151) but he doesn’t take any medications (the Rx “ran out”).  His BMI is 33.  No history of cardiac or lung disease is noted but on physical exam you note 2+ pitting edema, elevated JVP and rales. Vitals are stable (146/89; HR 85 and regular) with RA saturation of 94% without accessory muscle use.  You pursue further workup with chest x-ray, echocardiogram, and labs to determine the cause of his symptoms.  You suggest a one-week follow-up for BP reck and to discuss lab findings.

Assume “patient HF” is admitted to the hospital next week. Which of the following best describes proper post-hospitalization (and post-ED care, if that were the case) of patients with heart failure?

3. A 59-year-old female presents with non-exertional mid-sternal chest pain that is non-radiating. Her EKG is NSR, 82, and otherwise is normal. The pain started 3.5 hours ago and did not resolve with rest. She has no cardiac risk factors except for a mother who died of an acute MI at the age of 86. She does not smoke. Her BMI is 30. Additional work up in the emergency department showed normal labs and the cardiac enzyme test – a high-sensitivity cardiac troponin (hs-cTn) – with a limit of quantitation (LoQ) being 4 ng/L.  Clinically, this patient should be

4. The session mentioned the use of the HEART and EDACS scores as tools for ED evaluation of chest pain. The HEART score of a patient is 3 and the EDACS is 11.  This would indicate possible 

5. The Acute MI code can be used for patients for how long after the acute event?

6. There are five myocardial infarction types. The type associated with coronary artery disease with plaque rupture and thrombus is (pick the one best answer)

7. The following underused modality reduces odds of death by more than 50% compared to post MI patients, reduces readmissions, decreases global cost of care, and improves functional status, quality of life and mood (choose the best correct answer)….

8. Which of the following, if documented correctly, could aid in capturing an inpatient status for the heart failure patient on day ONE? Select all that apply.

9. The best practice recommendation for follow-up hospital visits with the PCP after a heart failure exacerbation is

10. True statements about atrial fibrillation (select all that are TRUE