CHF

Question 1

Etiologies for CHF

Answer 1

Most common cause is CAD. HTN, diabetes, alcohol abuse, infection, family hx of CM, valvular heart disease

Question 2

Is CHF a systolic or diastolic problem?

Answer 2

Can be both

Question 3

Left sided heart failure results in…

Answer 3

pulmonary edema

Question 4

Right sided heart failure results in…

Answer 4

peripheral edema

Question 5

Systolic problem resulting in CHF results in…

Answer 5

reduction of cardiac output- syncope, dyspnea, etc. And leads to congestion- R sided or L sided heart failure

Question 6

Significant dyspnea on exertion seen in systolic or diastolic dysfunction

Answer 6

Diastolic

Question 7

Causes of diastolic dysfunction in CHF

Answer 7

Myocardial ischemia, myocardial fibrosis, pressure overload hypertrophy, constrictive pericarditis, restrictive cardiomyopathy, HCM, amyloidosis or sarcoidosis CM

Question 8

Patient presents with dyspnea especially on exertion, fatigue, exercise intolerance, peripheral edema. Decreased concentration, confusion, oliguria tachycardia, . You are suspicious of CHF. What kind of signs do you look for during PE?

Answer 8

Weight changes, blood pressure, pulse, jugular venous distension (due to peripheral edema), pleural effusion, wheezes, rales, displaced PMI, Right ventricular heave, murmurs, gallops, hepatomegaly, splenomegaly

Question 9

DDx for CHF

Answer 9

Lung disease, pulmonary embolus, Pulm HTN, thyroid disease, arrhythmias, anemia, obesity, cognitive disorders, deconditioning

Question 10

What does BNP tell you

Answer 10

released from LV when it’s stretched. tells you if patient is in HF or not. If BNP greater than 500, heart failure. If less than 100, not related to heart. 100-500 heart or lungs problem

Question 11

what labs would you draw in CHF for diagnosis?

Answer 11

TOTAL PROTEIN, ALBUMIN, BUN, CREATININE- to make sure it’s not protein deficiency or leakage in periphery that is causing congestion, liver function tests, CXR, ECG, electrolytes, CBC, lipid panel, urinalysis,

Question 12

after CHF is diagnosed, figure out cause–

Answer 12

Echo- assess EF, valvular disease, hypertrophy, diastoligy. MUGA scan. Check systolic function - If EF less than 40%. Angiogram or exercise-stress test to r/o ischemia

Question 13

NYHA classification of CHF

Answer 13

Class 1- asymptomatic. Class 2- symptoms with moderate exertion. Class 3- Symptoms with minimal exertion. Class 4- Symptoms at rest

Question 14

ACC guidelines for CHF classification

Answer 14

Stage A- no cardiac dysfunction, but at risk for developing heart disease because of lifestyle risk factors (HTN, obesity). Stage B- Evidence of cardiac dysfunction, but no symptoms. Stage C- Evidence of cardiac dysfunctions WITH symptoms. Stage 4- Symptoms of heart failure despite maximal therapy.

Question 15

Why should you be careful of NSAIDS in hypertension and CHF?

Answer 15

can cause salt retention

Question 16

1st drug of choice in CHF

Answer 16

ACE-I

Question 17

contraindications for using ACE-I (for CHF)

Answer 17

renal artery stenosis, renal insufficiency, angioedema, hyperkalemia, severe aortic stenosis

Question 18

ARBs used in CHF

Answer 18

Candesartan and valsartan

Question 19

BB MOA in CHF

Answer 19

negative ionotrope, chronotrope.

Question 20

ACE-I plus BB

Answer 20

Improve EF, survival rate, and reduce sudden death

Question 21

contraindications for using BB in tx of CHF

Answer 21

bronchial asthma/emphysema, bradycardia, hypotensive, second or third degree heart block

Question 22

Spironolcactone reduces…

Answer 22

preload

Question 23

contraindications to using sprinolactone

Answer 23

renal insufficiency, hyperkalemia, gynecomastia

Question 24

Thiazide diuretics role

Answer 24

Inhibit Na/Cl reabsorption in distal convoluted tubule

Question 25

Loop diuretics role

Answer 25

Inhibit the Na/K/2Cl symporter in thick ascending limb

Question 26

What is the first line diuretic

Answer 26

loop diuretics

Question 27

Digoxin

Answer 27

Positive inotropic agent, enhances contraction.

Question 28

digoxin should be monitored carefully because toxicity can lead to..

Answer 28

severe bradycardia- digoxin delays AV conduction and reduces sinus node automaticity. Also decreases VR in atrial fibrillation. Can cause vision changes.

Question 29

Contraindication to using digoxin

Answer 29

kidney function should be normal!

Question 30

digoxin reduces morbidity or mortality?

Answer 30

reduces morbidity

Question 31

types of vasodilators used in CHF tx

Answer 31

ACE-I, nitrates, nesiritide, hydralazine

Question 32

function of ACE-I in tx of CHF

Answer 32

decrease preload (less reabsoption of sodium and water) and afterload (decrease vasoconstriction)

Question 33

function of vasodilators in tx of CHF

Answer 33

decreases afterload to increase cardiac output

Question 34

Positive inotropic agents, such as dixogin effect on mortality

Answer 34

good for short term, but long term use increases mortality

Question 35

types of positive inotropic agents

Answer 35

digoxin, dobutamine milrinone

Question 36

when to use positive inotropic agents in CHF

Answer 36

if patients have severely decreased CO and not perfusing. Can use it short term to perfuse until cardiac transplant

Question 37

what anticoagulant indicated for CHF

Answer 37

coumadin if risk of LV thrombus

Question 38

devices for CHF

Answer 38

implantable cardioverter defibrillator and biventricular pacemaker devices (EF must be less than 35% to be candidates)