ACUTE HEART FAILURE

Question 1

Classify what type of Acute HF

Signs and symptoms of AHF with relatively preserved left ventricular function, systolic blood pressure >140 mm Hg, typically with a chest radiograph compatible with pulmonary edema and symptom onset <48 h

Answer 1

Hypertensive AHF

Question 2

Classify what type of Acute HF

High cardiac output, typically with tachycardia, warm extremities, and pulmonary congestion

Answer 2

Right HF

Question 3

Classify what type of Acute HF

Signs and symptoms of AHF that are mild to moderate and do not meet criteria for hypertensive HF, pulmonary edema, or cardiogenic shock, systolic blood pressure <140 mm Hg and >90 mm Hg, typically associated with increased peripheral edema and symptom onset over several days

Answer 3

Acute on Chronic HF

Question 4

Classify what type of Acute HF

Typically with tachycardia, warm extremities, and pulmonary congestion

Answer 4

High-output failure

Question 5

Classify what type of Acute HF

Respiratory distress, rales on chest auscultation, reduced oxygen saturation from baseline, verified by chest radiograph findings

Answer 5

Cardiogenic Shock

Question 6

Classify what type of Acute HF

Respiratory distress, rales on chest auscultation, reduced oxygen saturation from baseline, verified by chest radiograph findings

Answer 6

Pulmonary Edema

Question 7

Management for Patients with pulmonary edema to decrease work of breathing

Answer 7

NIV

Question 8

usual cause of High-output failure (2)

Answer 8

Anemia, Thyrotoxicosis

Question 9

This results in a left ventricle that has difficulty RECEIVING blood.

Answer 9

Diastolic Dysfunction

Question 10

1. This results in a left ventricle that has difficulty EJECTING blood
2. Which leads to (2)

Answer 10

1. Systolic Dysfunction
2. increased intracardiac volume; afterload sensitivity

Question 11

POCUS: 3 questions to address

Answer 11

1. signs of pulmonary congestion: ≥2 of the 8 thoracic zones with ≥3 B-lines OR B-line count in all 8 zones ≥10
2. Are there signs of volume overload by measuring the size of the inferior vena cava and its collapsibility?
   a. IVC >2 cm with less than 50% collapse
   b. Evidence of acute RV strain
3. Is the left ventricular ejection fraction low or normal?

Question 12

Medication use in Hypertensive AHF which decreases mean arterial pressure by reducing preload

at high doses initially, it reduces afterload, may have coronary vasodilatory effects, decreasing myocardial ischemia and improving cardiac function

Answer 12

Nitroglycerin

Question 13

After vasodilator use in Hypertensive AHF, this drug may be given for symptom control

Answer 13

Loop diuretics

Question 14

Contraindication to start vasodilation (4)

Answer 14

1. right ventricular infarction
2. aortic stenosis
3. hypertrophic obstructive cardiomyopathy
4. hypotension: volume depletion increase the risk of vasodilator-associated hypotension

RAsHH

also anaphylaxis, sepsis, cardiogenic shock/MI

Question 15

This provide rapid symptomatic relief of congestive symptoms and improve the effects of angiotensin-converting enzyme inhibitors by decreasing intravascular volume.

Answer 15

Loop Diuretics