CHF

Question 1

Initial therapy of CHF?

Answer 1

Oxygen
Furosemide
Nitrates
Morphine

Question 2

Initial test in CHF?

Answer 2

CXR
EKG
Oximeter
Echo

Question 3

Treatments for systolic dysfunction CHF?

Answer 3

ACEI, ARBs, beta blockers (metoprolol, carvedilol; if contraindicated use hydralazine+nitrates), digoxin, mineralocorticoid (spironolactone, epleronone).

If still symptomatic add hydralazine and nitrates.

Question 4

Treatments for dyastolic dysfunction CHF?

Answer 4

MRAs (do not overdiurase)

Question 5

When is nesiritide the answer?

Answer 5

For preload reduction when IV inamrinone and IV milrinone fail. It is a synthetic vercion or BNP.

Question 6

Beta blokers that decrease mortality in CHF?

Answer 6

Metoprolol, carvedilol, bisoprolol.

Question 7

Why is digoxin used?

Answer 7

To decrease hospitalizations and symptoms but does not lowers mortality.

Question 8

What to use if the patient needs diuretics but has hyperkalemia?

Answer 8

Use patiromer (Ca/K exchange) or zirconium.

Question 9

If the patient is still dyspneic after optimal therapy, what do we use?

Answer 9

Sacubitril/valsartan (neprilysin inhibitor has mortality benefit in systolic dys.)
Ivabradine (inhibito of funny channels, slows heart rate).. Use only if pulse >70.

Question 10

Ivabradine side effect?

Answer 10

Brigh vision.

Question 11

When to add cardioverter/defibrillator? (biventricular pacemaker)

Answer 11

When EF <35% and QRS >120msec.

Question 12

When to add warfarin?

Answer 12

In patients with a-fib with metal valves or mitral stenosis.