71. Heart failure

Question 1

2 type of HF

Answer 1

Systolic
	HFrEF
	EF <40%
Diastolic
	HFpEF
	Poor filling pressures

Question 2

7 RF for HF

Answer 2

o	CAD
o	HTN
o	DM
o	Hyslipidemia
o	Obesity
o	Cocaine
o	EtOH

Question 3

what is Frank-starling doctrine

Answer 3

o Force of contraction is directly related to end diastolic stretch

Question 4

BP formula

Answer 4

COxSVR

Question 5

CO formula

Answer 5

HR x SV

Question 6

4 other sources of BNP

Answer 6

o Endothelial
o Vascular smooth muscle
o Renal
o Myocardium

Question 7

causes of acute HF

Answer 7

Na or volume excess
HTN
MI
infection
dysrhythmias
acute hypoxia
anemia
pregnancy
thyroid
myocarditis
valvular dysfunction
PE
sympathomimetic or EtOH

Question 8

use of BNP

Answer 8

o Myocyte stretch
o >500 associated with HF
o <100 highly unlikely
o Better predictor of outcome that physician judgment

Question 9

4 NYHA classes

Answer 9

1. No Sx with Phx activity
2. Sx with normal activity
3. Sx with less than normal activity
4. Sx at rest

Question 10

2 main types of HF in terms of mgmt

Answer 10

Well perfused

hypoperfused

Question 11

Tx of well perfused HF

Answer 11

Upright position
O2
- vent support PRN
- BiPAP, CPAP
Nitrites
Lasix
Morphine

Question 12

Tx of hypotensive patient

Answer 12

Hypoperfusion worsens coronary perfusion
May need vasopressors
o	Can increase afterload
Art line PRN
Fluid challenge improves in 50%
o	250ml 
o	If improves, repeat PRN

Question 13

Pressors for hypotension

Answer 13

• Norepi choice
• Catecholamine may increase work of heart that is already failing
• Epi of concerned of cardiac stunning, such as after CABG

Question 14

5 classes of meds for chronic HF

Answer 14

1. RAAS drugs
o	ACEi
	Most effective for LV dysfunction
	Start low and look for hypotension
2. BB
o	Increase EF and decrease mortality
o	Any patient with symptomatic LV HF
3. Diuretics
o	Low dose to prevent recurrence
o	Loops have more SEs
	hypoK and hypoMg
	HypoNa common and may be worse
4. Nitrates
o	Improves execise tolerance
o	Tachyphylaxis is biggest problem

5. Cardiac glycosides
   o Low dose Dig may have modest benefit

Question 15

indications for ICD

Answer 15

significant LV desyncrhony

Question 16

indication for CABG and angioplasty

Answer 16

o In EF <35% reduces cardiac death but not all told mortality

Question 17

5 possible other therapies for chronic HF

Answer 17

1 .PDE-5s
o	Limited use
	Hypoperfusion states
	Severe pulmonary hypertension
2. Statins
o	Early use after MI reduces risk of HF
o	Improves EF in severe HF
3. Anemia
o	Fe supplements
o	Improved LV function
4. Sleep apnea
o	Tx improves EF
5. Exercise
o	Improves