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Basics (Hx and PE) Flashcards

1
Q

What is the most sensitive symptom of heart failure?

A

Orthopnea (>=2 pillows)

Orthopnea refers to difficulty breathing when lying flat, often requiring multiple pillows to alleviate symptoms.

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2
Q

What is the most specific physical exam finding for heart failure?

A

Hepatomegaly (>4 fingerbreadths)

Hepatomegaly is an enlargement of the liver and can indicate congestive heart failure.

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3
Q

What has the highest positive predictive/likelihood ratio in heart failure diagnosis?

A

ASCITES

Ascites is the accumulation of fluid in the abdominal cavity, often associated with heart failure.

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4
Q

What has the highest negative predictive/likelihood ratio in heart failure diagnosis?

A

JVP >=12 mmHg

JVP stands for jugular venous pressure, and elevated levels can indicate heart failure.

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5
Q

What is the desirable amount of decrease in NTProBNP for heart failure?

A

> = 30%

NTProBNP is a biomarker used to diagnose and assess the severity of heart failure.

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6
Q
A
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7
Q

What is the half-life of BNP?

A

20 mins

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8
Q

What is the half-life of NTproBNP?

A

90 mins

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9
Q

What factors may increase NTproBNP levels?

A

ARNI and AGE

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10
Q

How does obesity affect NTproBNP levels?

A

Lower NTproBNP due to suppression

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11
Q

What is the desired decrease in BNP by hospital discharge?

A

Decreased >=30%

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12
Q

What is ST2 and its significance in heart failure?

A

From IL2 family; linked to progressive HF in all 4 stages; rising values associated with adverse outcomes

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13
Q

What is CPX used for in heart failure?

A

Identifying exercise intolerance and quantifying exercise capacity

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14
Q

How is VO2 related to cardiac output?

A

Direct function of CO

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15
Q

What is the prognostic significance of a VO2 max <14 mL/kg/min?

A

Moderate-severe heart failure

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16
Q

What is the prognostic significance of a VO2 max <10 mL/kg/min?

A

Severe heart failure; more prognostic if VE/VCO2 is >=45

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17
Q

How does in-hospital mortality compare between HFPEF and HFREF patients?

A

HFPEF patients have lower in-hospital mortality

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18
Q

What is a common reason for rehospitalization and death in AHF + HFPEF patients?

A

More likely to die from non-cardiovascular causes

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19
Q

What are prevalent diseases associated with heart failure?

A
  • Hypertension (66%)
  • CAD (50%)
  • Dyslipidemia (33%)
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20
Q

What dominates the clinical presentation of most patients hospitalized for heart failure?

A

Congestion (systemic or pulmonary)

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21
Q

What does clinical congestion resolving while hemodynamic congestion persists indicate?

A

Risk of rehospitalization

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22
Q

What shape change occurs due to increased LV filling pressures?

A

More spherical shape leading to worsening MR

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23
Q

What is the strongest predictor of worsening renal function in CHF patients?

A

Elevated CVP

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24
Q

What does worsening renal function in the setting of clinical improvement reflect?

A

Successful decongestion, not a poor prognosis

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25
What percentage of AHF hospitalizations are due to de novo or new onset HF?
20%
26
What triggers are commonly associated with AHF?
* 15% Pulmonary * 15% Myocardial Infarction * 14% Arrhythmia
27
What is associated with the highest in-hospital mortality in AHF?
Worsening renal function (8%)
28
How does non-adherence to diet/medication affect mortality in AHF?
2% increase in mortality for each; better prognosis
29
What is a common trigger for HFPEF patients?
Acute hypertension
30
What is the most common reason for seeking medical care in AHF?
Congestion
31
What is the most common symptom in AHF?
Dyspnea (90%)
32
What is the most common physical exam finding in AHF?
Rales/crackles (66-87%)
33
What is one of the strongest predictors of poor outcome in AHF?
Hypotension
34
What is the typical blood pressure in AHF patients?
Usually normal or elevated (>140 mmHg)
35
What is the significance of JVP in AHF assessment?
Barometer of systemic venous hypertension; single most useful PE finding
36
In which conditions is JVP not reliable?
* RV failure (infarct) * Severe TR * PAH
37
What does the absence of peripheral edema indicate in heart failure?
Does not exclude HF; equal to at least 4L water if clinically detectable
38
39
What is the CLASS I indication for heart failure?
BNP/NTproBNP and Troponin
40
What should be calculated instead of CREA alone?
EGFR
41
Which lab value relates more directly to the severity of heart failure than creatinine?
BUN
42
What is the single most useful test in evaluating the cause of acute heart failure (AHF) in patients?
ECHOCARDIOGRAPHY
43
What does E:Ea >15 indicate?
PCWP = 15
44
What type of care is required for urgent/emergent management of AHF?
Immediate care
45
What is a contraindication for non-invasive ventilation (NIV)?
Immediate need for intubation and lack of patient cooperation
46
How long is the typical door time for IV loop diuretics according to the ADHERE registry?
2.2 hours
47
What should patients with volume redistribution need?
VASODILATORS alone
48
What is the diuretic dose for patients with congestion who are on chronic diuretics?
1-2.5x the usual dose
49
What should be used for patients with severe cardiogenic pulmonary edema?
IV NITRATES
50
What is the most common arrhythmia requiring treatment in patients with AHF?
AF with RVR
51
What medication should be given for AF with RVR?
DIGOXIN
52
What is the most common cause of right-sided heart failure (RVHF)?
LEFT-SIDED HF
53
What is the best treatment for RVHF?
Early reperfusion
54
What should be done for RV dysfunction from pulmonary embolism?
Thrombolysis
55
What ventilation strategy should be used if ventilated with RV dysfunction from PE?
Use 8 mL/kg and low PEEP <12 cmH20
56
What defines cardiogenic shock?
SBP <80 lasting 30 mins, Cardiac index <1.8L/min/m2, PCWP >18 mmHg
57
What is the sodium restriction post hospital discharge?
2g
58
What is the water restriction post hospital discharge?
2L
59
What should not be discontinued after hospital discharge?
GDMT
60
When should beta-blockers (BB) be continued post-discharge?
Unless significant shock/cardiogenic shock
61
According to the PIONEER TRIAL, when is it best to transition Entresto?
In hospital setting
62
What defines cardiorenal syndrome?
CREA greater than 0.3 mg/DL, 25% decrease in eGFR
63
When should RAAS be discontinued?
If BUN >80 mL, CREA >3, Hyperkalemia
64
What is diuretic resistance associated with?
Increased length of stay/adverse prognosis

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