Congestive Heart Failure

Question 1

What are classes I-IV of HF?

Answer 1

I = not limited by symptoms
II = ordinary activity leads to s/sx
III = Marked limitations of ordinary activity
IV = s/sx at rest

Question 2

Which has a better prognosis: systolic or diastolic HF?

Answer 2

Diastolic

Question 3

What are the major causes of high output HF?

Answer 3

Paget's disease
Prego
Hyperthyroidism
AV fistulas
Beriberi

Question 4

What is the sputum like with CHF?

Answer 4

Pink and frothy

Question 5

How many cm indicated JVD?

Answer 5

4 cm

Question 6

What percent of patients with CHF will not have pulmonary congestion on CXR?

Answer 6

1/5

Question 7

What are the CXR findings associated with CHF?

Answer 7

• Cardiomegaly
• Cephalization of vessels
• Pleural effusions

Question 8

What sort of CXR films are needed to diagnose CHF via cephalization vessels?

Answer 8

Upright

Question 9

What is the sensitivity and specificity of BNP in the diagnosis of CHF?

Answer 9

90% sensitive

76% specific

Question 10

What is the therapy for hypotensive CHF pts?

Answer 10

AVOID nitrates and morphine

Give dopamine, dobutamine, NE, or milrinone

Question 11

What is the therapy for CHF pts with HTN?

Answer 11

Nitroprusside drip

Question 12

What is the treatment for diastolic CHF?

Answer 12

CCBs

Question 13

When is an AICD indicated in the treatment of HF?

Answer 13

If EF less than 35% with non-sustained v-tach

Question 14

When is an LVAD indicated for CHF?

Answer 14

WHen heart transplant indicated

Question 15

What are the initial steps to take in the ED with a pt presenting with CHF?

Answer 15

O2 (bipap)
Nitro if not hypotensive
Elevate the head of the bed

Question 16

How long may CXR findings lag clinical s/sx?

Answer 16

12 hours

Question 17

What are the drugs that must be avoided in hypotensive CHF pts? Why?

Answer 17

nitro
Morphine

Reduce bp further