Congestive Heart Failure

Question 1

Final and most severe manifestation of nearly every form of cardiac disease

Answer 1

CHF

Question 2

What is congestive heart failure pathophysiology?

Answer 2

Inability of the heart to pump blood forward at a sufficient rate to meet the metabolic demands of the body (forward failure) or the ability to do so only if the cardiac filling pressures are abnormally high (backward failure)

Question 3

What is the most common type of CHF?

Answer 3

Systolic

Question 4

What is the main risk factor for CHF?

Answer 4

CAD number one cause for failure

Question 5

What are the major causes of death from CHF?

Answer 5

arrhythmias and pump failure

Question 6

What is the most common cause of right sided heart failure?

Answer 6

Left sided heart failure

Question 7

Causes of left sided heart failure

Answer 7

Myocarditis
Pericarditis
Valvular heart disease
Myocardial remodeling

Question 8

Causes of right sided heart failure

Answer 8

Left sided heart failure
Pulmonary valve stenosis
RV infarct
COPD
ARDS
Chronic lung infection
PE
Primary pulmonary HTN

Question 9

List some factors that can aggrevate heart failure

Answer 9

Medications
New heart disease
Myocardial ischemia
Pregnancy
Arrhythmias
Infections
Thromboembolism
Hyper/hypothyroidism
Endocarditis
Obesity
HTN
Noncompliance
Dietary excess

Question 10

NY Classification 1

Answer 10

No symptoms or only symptoms
at high exertion (running)

normal

Question 11

NY Classification 2

Answer 11

Symptoms on ordinary exertion
Walking around the block

Question 12

NY Classification 3

Answer 12

Symptoms on minimal exertion
Walking to the next room

Question 13

NY Classification 4

Answer 13

Symptoms at rest

Question 14

Stage A HF

Answer 14

High risk for developing HF
Patient has risk factors
Has normal EF

Question 15

Stage B HF

Answer 15

High risk for developing HF

Asymptomatic LV dysfunction
Decrease in EF
No edema, pulmonary issues, etc
Structural heart disease

Question 16

Stage C HF

Answer 16

Reduced EF

Past or current symptoms of
CHF
Never leave this category – can be
in this category with no symptoms

Question 17

Stage D HF

Answer 17

End stage CHF
Heart is giving out

Question 18

CXR Findings in Heart Failure

Answer 18

Cardiac silhouette – enlarged/cardiomegaly
pulmonary congestion
Pulmonary edema (Butterfly or bat-wing pattern)
Redistribution of blood flow from bases to apices (cephalization)

Question 19

Kerley B lines

Answer 19

Abnormal septal lines seen in HF
(wispy lines on outside of lungs)

Question 20

What is BNP and why is it important?

Answer 20

B-type Natriueretic Peptide

Expressed primarily in the ventricles and is elevated when ventricular filling pressure are high

Only secreted during heart failure in response to intracardiac pressures (the higher the number, the worse the heart failure)

Normal levels rule out acute HF in the emergency setting

Can also be used to monitor progress of HF

Question 21

What class of medication prevent the negative remodeling of the LV and help prevent development of HF?

Answer 21

ACE/Arbs
Slows progression, prolong survival

Question 22

First line medication in heart failure

Answer 22

ACE inhibitors

Question 23

What class of medication in HF is used to improve survival and mortality rates in all stages of HF

Answer 23

Beta Blockers

Question 24

What class of medication is the most effective means of providing symptomatic relief in moderate to severe HF (Relieve symptoms of HF but NO effect on progression or survival)

Answer 24

Loop Diuretics

Question 25

Therapies to Avoid in CHF and Why

Answer 25

Thiazoladinediones (Glitazones) - Medication for DM that can worsen HF

Calcium channel blockers - NONE for CHF – decrease iontrophy; Systolic failure leads to increased mortality

NSAIDs and COX2 inhibitors - Cause Na+ and water retention

Question 26

Causes of diastolic dysfunction heart failure

Answer 26

HTN
Hypertrophic cardiomyopathy
Myocardial infarction
Restrictive cardiomyopathy
Aortic stenosis with normal EF
Coronary artery disease

Question 27

Acute Heart Failure Contraindicated Medication Class

Answer 27

Beta Blockers

Question 28

What is the most common symptom in left sided heart failure?

Answer 28

Dyspnea

Question 29

What is the most common symptom in right sided heart failure?

Answer 29

Peripheral Edema