CHF

Question 1

Causes of left sided HF (w/ most common) (HFrEF)

Answer 1

CAD (60-70%)
HTN
Idiopathic - usually dilated cardiomyopathy
Valvular disease - AS, AR, MR
Alcoholic - dilated cardiomyopathy
Medication non compliance

Question 2

Most common cause of right sided HF

Answer 2

left sided heart failure

Question 3

Causes for acute CHF exacerbations

Answer 3

new cardiac insult - MI, arrhthymia, valvular disease
New demand on CV system = HTN, anemia, infection, thyrotoxicosis
Medication non-compliance
Dietary indiscretion - increased Na intake
OSA

Question 4

Acute treatment for CHF

Answer 4

LMNOPP
l - lasix - 40-500 mg IV
M - morphine - 2-4 mg IV
N - nitro (do not use in R sided HF bc it will precipitate further cardiac collapse)
O - oxygen if hypoxic
P - positive airway pressure - CPAP, BiPAP as it decreases preload and need for ventilation
P - positioning - sit patient up with legs hanging if not hypotensive

Question 5

Lifestyle management for heart failure

Answer 5

low Na intake <2300 mg/day
fluid restriction, <2L/d
exercise - avoidance can lead to worsening deconditioning, 3-5x/w
DM control
BP control
cholesterol control
smoking cessation
decreasing etoh consumption
weight loss if pt >40 BMI - highest survival rate in patients w/ BMI 30-32
Avoid NSAIDs

Question 6

Pharmacological management for HfrEFH that have shown a mortality benefit

Answer 6

ARNI (entresto)/ACEI/ARB
MRA (spironolactone)
BB
SGLT2i

Question 7

Pharmacological management for HFpEF

Question 8

Causes of HFpEF

Answer 8

CAD (Ischemic)
DM
HOCM
HTN
restrictive cardiomyopathy
Combination of HTN, obesity, DM, COPD, sedentary lifestyle, iron deficiency