Congestive Heart Failure

Question 0

NYHA HF classification

Answer 0

I: No limitation of activity; no symptoms with normal activity
II: Slight limitation of activity; comfortable at rest or with mild exertion
III: Marked limitation of activity; comfortable only at rest
IV: Any physical activity brings on discomfort; symptoms present at rest

Question 1

Risk factors

Answer 1

CAD, HTN, Diabetes, Valvular disease, Cardiomyopathy

Question 2

Diuretic effects on calcium

Answer 2

Loops lose calcium, thiazides keep it in
Loop diuretics: hypocalcemia
Thiazides: hypercalcmia

Question 3

Definition of systolic dysfunction

Answer 3

EF < 50%
Increased LV end-diastolic volumes
2/2 inadequate LV contractility or increased afterload. This leads to hypertrophy and ventricular dilation, increasing myocardial work and worsening systolic function

Question 4

Sytolic dysfunction physical exam

Answer 4

Parasternal lift, elevated and sustained LV impulse, S3/S4, JVD, peripheral edema

Question 5

Kerley lines

Answer 5

CXR finding c/w interstitial pulmonary edema

Question 6

Treatment for acute systolic heart failure

Answer 6

Correct underlying causes
Diurese aggresively w/ loop and thiazide diuretics
ACEI or ARB
B-blocker as long as long as patient is not decompensated
LMNOP: lasix, morphine, nitrates, O2, position

Question 7

Tx for chronic systolic failure

Answer 7

Basically: beta-blockers, ACEI and spironolactone have long-term mortality benefit. Digoxin and diuretics only have symptomatic benefit

Beta blockers and ACEI/ARB help prevent remodeling of the heart and have a mortality benefit
-avoid CCBs
Spironolactone: proven mortality benefit
ASA and statin
Chronic diuretics ie Lasix; no mortality benefit
Anti-coagulation if required

ICD if EF < 35%

Question 8

Long term CHF treatment with mortality benefit

Answer 8

Beta blockers, ACEI (both prevent remodeling)

Spironolactone

Question 9

Number one cause of systolic heart failure

Answer 9

HTN -> LVH -> systolic HF

Question 10

Main causes of diastolic dysfunction

Answer 10

LVH, restrictive cardiomyopathy, ischemia, hypertrophic cardiomyopathy, aortic stenosis

Question 11

Definition of diastolic heart failure

Answer 11

High LVEDP
Decreased ventricular compliance with normal systolic function
-ventricle has impaired active relaxation (2/2 ischemia, aging, hypertrophy) or impaired passive filling (scarring from prior MI, restrictive cardiomyopathy)

Question 12

Treatment of diastolic dysfunction

Answer 12

Diuretics are first line tx
Maintain rate and BP control w/ beta-blockers, ACEI, ARBs, or CCB
DO NOT USE DIGOXIN IN THESE PATIENTS, IT HAS NO BENEFIT