Congestive Heart Failure

Question 1

Define heart failure, and HFrEF vs HFpEF?

Answer 1

HF - physiology state insufficiency to meet needs of body and lungs

HFrEF - reduced ejection fraction -> EF <40% (systolic dysfunction)

HFpEF - preserved ejection fraction -> EF >45% (diastolic dysfunction)

Question 2

What are some nonischemic causes of HF?

Answer 2

Anemia, thyroid disease, HIV, doxorubicin, amyloid, Fabry’s disease

Question 3

What is cardiac index?

Answer 3

Cardiac output / body surface area

Normalizes cardiac output to the body surface area

Question 4

What does heart failure classing vs staging do?

Answer 4

Classing - Class I-IV, based on severity of symptoms during activity. Easy to do, but changes day to day and can move back and forth.

Staging - A-D. Does not change based on how you’re feeling.

Question 5

What are the stages of heart failure?

Answer 5

A - high risk for future HF
B - Structural disease w/ no symptoms
C - Previous symptoms, but medically managed
D - Refractory HF - special treatment required

Question 6

Will all people with HF have rales and lower extremity edema?

Answer 6

No -> it is often well compensated by the lymphatic system. And these symptoms cna be nonspecific

Question 7

What are the three best measures of heart failure on physical exam?

Answer 7

1. Jugular venous distension (JVD)
2. Pulsatile liver
3. Hepatojugular reflex

Question 8

What are pulsatile liver and hepatojugular reflex?

Answer 8

Pulsatile liver - can actually see the pulsations due to fluid overload

Hepatojugular reflex - pushing on the liver will increase the JVP by forcing blood into the IVC

Question 9

What are nuclear SPECT and Cardiac PET good at detecting?

Answer 9

SPECT - see what areas are taking up dye and are working hardest, plus what the dilation pattern of the ventricle is

PET - looks at ischemia / viability of myocytes

Question 10

What are cardiac MRI / cardiac CT good for?

Answer 10

Good for seeing amyloid deposition / restrictive cardiomyopathies

Question 11

Why is it important to check for TSH and iron in labs?

Answer 11

Hyper / hypothyroidism as well as hemochromatosis represent reversible causes of heart failure.

Question 12

Is BNP the gold standard for heart failure progression? How?

Answer 12

No, it’s not super sensitive / specific, don’t rely on it alone.

Normal is <50
Heart failure is >500

Issue is, BNP can start dropping off if you have structural changes in the heart so you can’t produce it as well

Question 13

What are the fluid and sodium targets for HF?

Answer 13

Fluid restriction: <2 L/day

Na+ restriction: <2 gm/day, hardest part

Question 14

Why is spironolactone so juicy?

Answer 14

Despite not being the best diuretic, it prevents fibrosis / remodelling of the heart tissue

Question 15

What is an ICD / what is its function?

Answer 15

Implantable cardioverter defibrillator

• > instantly terminates Vtach / Vfib if need be
• > 1st line preventative treatment for sudden cardiac death

Question 16

What is a BiV-ICD / CRT-D/CRT-P?

Answer 16

Biventricular implantable cardioverter defibrillator
or
Cardiac resyncronization therapy defibrillatory / pacemaker

Can pacemaker or defibrillate both ventricles if things get out of wack, depending on what patient prefers?

Question 17

What is OptiVol used for?

Answer 17

Monitoring of plasma volume to determine diuretic dose increase or decrease

“Optimal volume”

Question 18

What are LVAD / RVAD / BiVAD used for / how do they work?

Answer 18

They sit as mechanical devices in the abdomen, taking blood from the ventricle and pumping it in to the corresponding vessel

BiVAD = biventricular assitance device

Question 19

What is a total artificial heart? Can patient leave hospital?

Answer 19

A double pumping chamber connected directly to PA / aorta.

Patient cannot leave hospital, must wait for the heart for transplant.