Acute Decompensated Heart Failure

Question 1

True or false: Most HF hospitalizations for decompensation are acute

Answer 1

False. Most are not truly acute, they occur as a result of gradual filling pressures on preexisting structural heart disease

Question 2

What are two big factors in acute decompensated heart failure?

Answer 2

. Medication related- non adherence
. Disease related- non adherence to fluid/sodium restrictions, MI, uncontrolled HTN

Question 3

Components that help in diagnosis of ADHF

Answer 3

. Detailed history and physical exam
. BNP or NT-pro-BNP
. Hemodynamic monitoring

Question 4

Patients taking Entresto should have what lab value monitored?

Answer 4

pro-BNP

Question 5

What are the four categories of ADHF clinical presentation? What do they mean?

Answer 5

I- Warm and dry
II - Warm and wet
III - Cold and dry
IV - Cold and wet

Wet/dry = fluid status
Warm/cold = cardiac function

Question 6

At what BNP and pro-BNP levels do you exclude ADHF in patients with dyspnea of unknown etiology?

Answer 6

BNP < 100
NT-proBNP < 300

Question 7

_____-_____ is an invasive method of hemodynamic monitoring and is not recommended

Answer 7

Swan-Ganz

Question 8

True or false: Hospitalization for heart failure is considered a sentinel event

Answer 8

True

Question 9

What are the three main drug classes used in ADHF?

Answer 9

. Diuretics
. Inotropes
. Vasodilators

Question 10

General management for cold and dry subset

Answer 10

. PCWP < 15 = IVF until 15 - 18
. PCWP > 15, SBP < 90 = Inotrope
. PCWP > 15, SBP ≥ 90 = Vasodilator

Question 11

General management for warm and dry subset

Answer 11

Optimize PO medications

Question 12

General management for warm and wet subset

Answer 12

IV diuretics

Question 13

General management for cold and wet subset

Answer 13

IV diuretics ±
SBP < 90 = Inotrope ( + vasopressor)
SPB ≥ 90 = Vasodilator

Question 14

What are indicators of hemodynamic instability?

Answer 14

. Change in mental status
. SBP <90
. Cold and clammy
. Ongoing chest pain

Question 15

What drug class is considered first line treatment for ADHF associated with fluid overload? Which medication in this class is most commonly used?

Answer 15

Diuretics. Furosemide

Question 16

An ADHF patient hospitalized for fluid overload should be given the IV equivalent of ____ times their at home oral diuretic dose
a. 2
b. 2.5
c. 3
d. 4

Answer 16

d. 4

Question 17

Which medication class is used in conjunction with diuretics to manage pulmonary congestion in subset II or IV of HF?

Answer 17

Vasodilators

Question 18

Which medication can be used instead of inotropes in patients with elevated SVR and low CO?

Answer 18

Nitroprusside

Question 19

Most patients have evidence of congestion (with/without) apparent hypoperfusion

Answer 19

Without

Question 20

Which types of diuretics are used in treating ADHF?

Answer 20

. Loop diuretics
. Thiazide diuretics