CHF

Question 1

what is the pathophysiology of CHF

Answer 1

decreased cardiac output due to diseased heart leads to SANS activation and Renin-Angio-Aldosterone system all leading to systemic vasoconstriction

venous return increases, so preload increases

diseased heart cannot handle increased preload so the LV end diastolic volume goes up, backs up into the lungs and causes pulmonary HTN and congestion

Question 2

what is a common cause of both systolic and diastolic heart dysfunction leading to CHF

Answer 2

chronic HTN that leads to cardiomyopathy

Question 3

What is the New York Heart Association classification of CHF? (I-IV)

Answer 3

I: Sx with vigorous activity
II: Sx with prolonged moderate exertion
III: Sx with usual activities like walking or dressing
IV: Sx at rest, incapacitating

Question 4

What tests should be run in patients suspected of CHF

Answer 4

ECG
CXR
cardiac ezymes
CBC (anemia)

Question 5

CXR characteristic indicating lung congestion in due to dilated pulmonary lymphatic vessels

Answer 5

Kerley B lines

-horizontal lines along the periphery of the lung fields

Question 6

Test used to differentiate dyspnea due to CHF vs COPD

Answer 6

BNP (brain natriuretic peptide)

-raised in CHF

Question 7

What EF is associated with CHF?

Answer 7

less than 40%

Question 8

Only drug class known to reduce mortality in CHF

Answer 8

ACE-Is

Question 9

What are the standard treatment regimens for CHF NYHA classes?

Answer 9

I to II
-sodium restriction, loop diuretic, ACEI
Mild II to III
-diuretic loop and ACE, Beta Blocker
Severe III to IV
-all previous plus digoxin

Question 10

Should metformin be used in CHF?

Answer 10

NO,

may cause lactic acidosis