Congestive Heart Failure

Question 1

Definition of congestive heart failure

Answer 1

Cardiac pumping capacity that is inadequate to meet the body’s metabolic needs

Question 2

What are the MC causes of CHF?

Answer 2

CAD and HTN

Question 3

What will systolic (L sided) heart failure do to the heart and show on PE?

Answer 3

• LV remodeling
• Fatigue, crackles, DOE, PND
• Cheyne-Stokes respiration (apnea to hypervent to apnea)

Question 4

What will diastolic (R sided) heart failure do to the heart and show on PE?

Answer 4

• Disruption in diastolic filling or contractility of RV

- Peripheral pitting edema, GI tract congestion

Question 5

What does CHF show on CXR?

Answer 5

Kerley B lines (interstitial edema)

Question 6

What lab is most useful in assessing for CHF?

Answer 6

BNP (released by stretched myocardium)

Question 7

What is the treatment of CHF?

Answer 7

• Treat reversible causes (HTN, DM)
• Diuretics
• ACEI/ARBs reduce mortality rates

Question 8

What is the role of BBs in CHF?

Answer 8

• Previously controversial, contraindicated

- Now strongly recommended if symptoms have been stable

Question 9

What is the role of digoxin in CHF?

Answer 9

• Reduced HF exacerbations

- BUT increased mortality due to arrhythmias and MI

Question 10

What is the role of vasodilators in CHF?

Answer 10

• Improves SOB

- BUT no improvement in limiting advancement of CHF

Question 11

When is a defibrillator indicated for CHF?

Answer 11

HF and cardiomyopathy with EF less than 35%

Question 12

When is biventricular pacing indicated in CHF?

Answer 12

HF and EF less than 35% with LBBB

Question 13

What lifestyle changes are encouraged with CHF?

Answer 13

• Sodium restriction

- Exercise

Question 14

What are the newer/future meds for CHF?

Answer 14

• Ivabradine (selective sinus node inhibitor for rate control)
• Ranolazine (anti-ischemic agent)
• Tolvaptan (anti-hyponatremia)
• Sildenafil (decreases pulm vasc resistance)
• Serelaxin (recombinant form of hormone relaxin)

Question 15

What is acute decompensated failure?

Answer 15

• Worsening of HF symptoms
• Pulm edema
• Acute or subacute worsening of dypsnea

Question 16

How to treat acute decompensated failure?

Answer 16

• Sit upright, oxygen
• Morphine, diuretic both IV
• Nitrates
• CPAP

Question 17

What causes post-partum cardiomyopathy?

Answer 17

Unknown - autoimmune maybe?

Question 18

What are the criteria to diagnose post-partum cardiomyopathy?

Answer 18

1. Absence of identifiable cause of pulm edema
2. Development of HF w/in last month of pregnancy or 5 days of delivery
3. Absence of recognizable cardiac disease before last month of pregnancy
4. LV systolic dysfunction on echo