CHF: Systolic Dysfunction

Question 0

In CHF staging, can you move up and down?

Answer 0

just up

Question 1

NYHA Classification

Answer 1

I- cardiac dz without sxs 
II- fatigue/palpitations/dyspnea w/ ordinary activity
IIIa- less than ordinary activity sxs 
IIIb- minimal activity sxs
IV- rest pain

Question 2

Describe the CHF staging system

Answer 2

Stage A- high risk for HF. no actual HF.
Stage B- structural dz
Stage C- structural dz + sxs ever
Stage D- refractory HF needing special intervention

Question 3

do BB prevent recurrent MI for patients with HF?

Answer 3

yes

Question 4

what is BNP NOT meant to be?

what are BNP/NT-BNP affected by (x3)

Answer 4

a screening tool

age, renal function (inc.), obesity (dec.)

Question 5

> ? BNP in ED has a PPV of 90%?

Answer 5

500

Question 6

<? BNP in ED has NPV of 90%?

Answer 6

100

Question 7

is a CXR recommended for all HF patients?

Answer 7

yes

Question 8

name two variables that are strong predictors of mortality/survival on a CPET (cardiopulm exercise test)

Answer 8

VO2

VE/VCO2

Question 9

routine Bx in HF is not recommended. Name 3 cases where it is recommended.

Answer 9

rapidly progressive HF despite med Rx
suspect infiltrative process
malignant arrhythmias out of proportion to LV dysfxn (r/o giant cell myocarditis, sarcoid)

Question 10

in pt’s with CHF< at what EF do you start an ACEI?

Answer 10

<40%

Question 11

What did SOLVD trial show in HF?

Answer 11

enalapril lowers mortality and hospitalizations c/w placebo

Question 12

3 BB that decrease mortality

Answer 12

carvedilol
metoprolol succinate
bisprolol

Question 13

when would you start carvedilol for HF? Toprol XL?

Answer 13

carvedilol- high BP, DM/IGT

metoprolol succinate- marginal BP, causes less bronchospasm

Question 14

RALES showed what?

Answer 14

mortality benefit with spirinolactone in pt’s with Class III or IV HF already on ACE/BB.

Question 15

RALES exclusion criteria

Answer 15

Cr>2.5

K>5

Question 16

what did EMPHASIS trial show over the RALES trial?

Answer 16

mortality benefit with eplerenone even with Class II HF.

Question 17

which trial showed that you can consider hydrazine/isordil in any pt (not just AA’s) w/ HF Class II or greater b/c of survival benefit?

Answer 17

A-HeFT

Question 18

do diuretics dec. mortality?

Answer 18

no

Question 19

causes of diuretic refractoriness

Answer 19

noncompliance
hypotension or renal artery stenosis or CRI
low CO

Question 20

name a diuretic you can give if sulfa allergy

Answer 20

ethacrynic acid

Question 21

what class of drugs are amiloride and triamterene?

Answer 21

potassium sparing diuretics

Question 22

what level do you want dig to be?

Answer 22

<1 (.7-.9)

Question 23

what is the major medication to adjust if you are on amiodarone?

Answer 23

warfarin!

Question 24

do you give anabolic steroids to cachectic pt’s?

Answer 24

no