Cardiology

Question 1

what are the 2 main etiologies for HF?

Answer 1

ischemic vs non-ischemic

Question 2

what is the pathophysiology for cardiorenal syndrome?

Answer 2

Systolic dysfunction → ↓ cardiac output → renal hypoperfusion → prerenal kidney failure

Diastolic dysfunction → systemic venous congestion → renal venous congestion → ↓ transglomerular pressure gradient → ↓ GFR → ↓ kidney function

Question 3

should BB be stopped in ADHF?

Answer 3

usually can and should continue, unless there is presence or high risk of cardiogenic shock, and do not start a BB if not taking one at home

Question 4

GDMT options for afterload reduction

Answer 4

ACEi and ARB, ARNI, hydralazine/isosorbide dinitrate

Question 5

should ACEi/ARB or ARNI be discontinued in the case of renal dysfunction while diuresing?

Answer 5

usually should continue in cases of mild renal dysfunction

Question 6

what should you get instead of BNP while on sacubitril?

Answer 6

pro-BNP (sacubitril will falsely elevate BNP)

Question 7

how do you switch a patient from an ACEi to an ARNI?

Answer 7

need a 36 hour washout period (reduce risk of hypotension, AKI and hyperkalemia as well as potential angioedema)

Question 8

what does a neprilysin inhibitor do?

Answer 8

inhibits the enzyme that degrades natriuretic peptides

Question 9

target Cr and K for aldosterone antagonists

Answer 9

Cr <2.5 and K <5

Question 10

how do SGLT-2 inhibitors work? (empagliflozin and dapagliflozin)

Answer 10

block resorption of sodium and glucose in the proximal tubules

Question 11

when should you get a BNP for HF patients?

Answer 11

right on admission and within 72 hours of discharge (since ideally they would be more euvolemic at this time and gives a good baseline then)