Disorders of Extracellular Fluid Volume: Heart Failure

Question 1

What characterizes heart failure (HF)?

Answer 1

Decreased cardiac output, Na⁺ retention, and ECF volume expansion despite normal kidneys.

Question 2

What is the role of neurohumoral activation in heart failure?

Answer 2

Impaired baroreceptor reflexes → ↑ SNS → Na⁺ reabsorption.

Question 3

Differentiate between ‘Backward’ and ‘Forward’ failure in heart failure.

Answer 3

‘Backward’: Venous congestion → ↑ hydrostatic pressure → edema.
‘Forward’: ↓ Cardiac output → ↓ tissue perfusion → Na⁺ retention.

Question 4

What does a decrease in effective arterial blood volume (EABV) lead to in heart failure?

Answer 4

Activates RAAS/SNS/ADH and attenuates ANP/BNP.

Question 5

Fill in the blank: CHF → ↓EABV → ↑RAAS/SNS/ADH + ↓ANP → Na⁺/H₂O retention → _______.

Answer 5

Edema

Question 6

What are the common symptoms of heart failure?

Answer 6

• Dyspnea
• Orthopnea
• Edema
• Ascites

Question 7

What signs are associated with heart failure during a physical examination?

Answer 7

• JVD
• Crackles
• S₃ gallop
• Pitting edema

Question 8

What laboratory tests are important in evaluating heart failure?

Answer 8

• CBC
• Electrolytes (watch for hyponatremia/hypokalemia)
• BUN (>43 mg/dL prognostic)
• Liver enzymes
• ECHO

Question 9

What dietary recommendations are made for ambulatory patients with heart failure?

Answer 9

Na⁺ restriction (2–5 g/day); avoid salt substitutes (K⁺ risk).

Question 10

What are the first-line diuretics for managing edema in heart failure?

Answer 10

Loop diuretics (furosemide 20 mg BID, titrate up).

Question 11

What strategies can be employed for diuretic resistance in heart failure?

Answer 11

• Double dose
• Switch to IV
• Combine diuretics
• Hypertonic saline
• Avoid NSAIDs (worsen Na⁺ retention)

Question 12

What is the initial IV diuretic treatment for hospitalized patients with acute decompensated heart failure (ADHF)?

Answer 12

Furosemide 40 mg bolus or 5–10 mg/h infusion.

Question 13

What additional treatments may be used for hospitalized patients with ADHF?

Answer 13

• Thiazides if poor response
• Nitroprusside/nitroglycerin for afterload reduction

Question 14

What inotropic agents are used for severe cases of heart failure with EF <40%?

Answer 14

• Dobutamine
• Milrinone

Question 15

What is the treatment for cardiorenal syndrome type 1?

Answer 15

Loop + thiazide diuretics, ultrafiltration.

Question 16

What is the treatment for cardiorenal syndrome type 2?

Answer 16

ACE-Is, loop/K⁺-sparing diuretics.

Question 17

For cardiorenal syndrome type 3, what is the treatment focus?

Answer 17

Treat arrhythmias/fluid overload.

Question 18

What management strategies are suggested for noncompliant heart failure patients?

Answer 18

• IV furosemide → oral transition + salt restriction
• Add metolazone if resistance (urinary Na⁺ 20 mEq/L)

Question 19

What key points are noted for diuretic-resistant cardiorenal syndrome?

Answer 19

• EF 40% + hypotension → inotropes (dobutamine/milrinone)
• Ultrafiltration for refractory edema/AKI

Question 20

What medications are recommended for postdischarge care in heart failure?

Answer 20

• ACE-Is/ARBs
• Spironolactone
• β-blockers (carvedilol)

Question 21

What monitoring practices are advised for postdischarge heart failure patients?

Answer 21

• Daily weights
• Electrolytes
• Avoid NSAIDs

Question 22

True or False: EABV ↓ drives Na⁺ retention in heart failure despite ↑ECF volume.

Answer 22

True

Question 23

What should be checked to address diuretic resistance in heart failure?

Answer 23

Check urinary Na⁺, use combos, consider ultrafiltration.

Question 24

What is the importance of tailoring therapy in cardiorenal syndrome management?

Answer 24

To address the interplay between heart failure and chronic kidney disease.

Question 25

Fill in the blank: In heart failure management, avoid _______ as it worsens Na⁺ retention.

Answer 25

NSAIDs