Exam 1: Heart Failure

Question 1

What is heart failure?

Answer 1

Complex clinical syndrome that can results from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood

Question 2

What is left heart systolic dysfunction ?

Answer 2

Impaired cardiac contractile function

Question 3

What is left heart diastolic dysfunction?

Answer 3

Abnormal cardiac relaxation

Question 4

What is HFrEF? Systolic or diastolic?

Answer 4

Heart failure with reduced ejection fraction, systolic

Question 5

What is HFpEF? Systolic or diastolic?

Answer 5

Heart failure with preserved ejection fraction, diastolic

Question 6

How does HFrEF present?

Answer 6

Systolic dysfunction, reduced left ventricular EF (< 40%) and increased LV volumes
-Eccentric remodeling

Question 7

What are the causes of HFrEF?

Answer 7

Impaired contractility (CAD and cardiomyopathy) and high afterload (HTN)

Question 8

How does HFpEF present?

Answer 8

Diastolic dysfunction, normal LVEF, normal to decreased LV end diastolic volume (increased pressure)
-Concentric remodeling

Question 9

What determines LV diastolic pressure?

Answer 9

The volume of blood in ventricle and distensibility or compliance of the ventricle.

Question 10

When LV diastolic pressure increases, what else increases?

Answer 10

Pulmonary venous pressures, which may cause pulmonary arterial pressure which increases afterload on the right ventricle (may lead to RHF)

Question 11

When compared to HFrEF, patients with HFpEF tend to be…?

Answer 11

Older, have HTN, overweight, and women

Question 12

What is the most common cause of right heart failure?

Answer 12

Left heart failure

Question 13

What is the most common underlying cause of heart failure?

Answer 13

CAD

Question 14

What are the most common symptoms seen with heart failure?

Answer 14

Dyspnea, fatigue, dependent edema, and weight gain

Question 15

Does right or left heart failure have decreased cardiac output and pulmonary congestion?

Answer 15

Left heart failure

Question 16

Does right or left heart failure have congestion of peripheral tissues?

Answer 16

Right heart failure

Question 17

What kind of heart failure is most likely causing the following symptoms: Peripheral edema, RUQ pain, JVD, and ascites.

Answer 17

Right heart failure

Question 18

What CXR findings are suggestive o HF?

Answer 18

Cardiomegaly, cephalization of Pulmonary vessels, kerley B lines, and pleural effusions

Question 19

What labs should you order when your patient has heart failure?

Answer 19

Cardiac enzymes, CBC, CMP, and BNP

Question 20

When is ordering a BNP useful?

Answer 20

Diagnosing HF, risk stratification, and guiding the treatment of patients with HF

Question 21

What kind of patients should you order a BNP for?

Answer 21

Patients presenting with dyspnea to support a diagnosis of HF, or in patients with chronic HF on admission to the hospital to establish prognosis in acutely decompensated HF

Question 22

What is recommended initial therapy for HFrEF?

Answer 22

ACE inhibitor and diuretic

Question 23

When prescribing diuretics, what medication and dosage should you start with?

Answer 23

20-40mg furosemide

Question 24

When should you use ARBs?

Answer 24

When ACE inhibitors are not tolerated

Question 25

If a patient has a normal EKG, what kind of heart failure is unlikely?

Answer 25

Systolic dysfunction

Question 26

What should you do when placing your patient on diuretics?

Answer 26

Monitor renal function and electrolytes (hypokalemia)

Question 27

What should you do when placing your patient on an ACE inhibitor?

Answer 27

Monitor blood pressure, renal function, electrolytes (hyperkalemia)

Question 28

When are MRAs indicated?

Answer 28

Patients with at rest dyspnea within the past 6 months

Question 29

When is hydralazine indicated?

Answer 29

Patients who cannot take ACE, ARB, or ARNI | -Add on therapy for African American patients

Question 30

When is Ivabradine used?

Answer 30

patients with chronic HFrEF, LV ejection fraction of less than 35% in NSR, resting HR is greater than 70 on max dose beta blocker, or use of beta blocker is contraindicated

Question 31

When you having a patient on digoxin, what should their serum levels be?

Answer 31

Between 0.5 and 0.8

Question 32

What are the most common causes of death in patients with heart failure?

Answer 32

Progressive pump failure and malignant arrhythmias

Question 33

What is acute decompensated heart failure?

Answer 33

A complication of HF, elevated left sided filling pressures and dyspnea with or without pulmonary edema

Question 34

What most often causes cardiogenic pulmonary edema?

Answer 34

Acute decompensated heart failure

Question 35

What is often seen on CXR in patient with cardiogenic pulmonary edema?

Answer 35

Kerley B lines, edema, and cardiomegaly.

Question 36

You see a patient with dyspnea and a productive cough itch pink and frothy sputum. What should you be concerned about?

Answer 36

Cardiogenic pulmonary edema

Question 37

How does heart failure progress?

Answer 37

Damage to the myocardium (either abrupt, gradual, or hereditary) and then progressive disease (contributes to cardiac remodeling and there is neurohormonal imbalance cause by overactivation of the renin angiotensin aldosterone system)

Question 38

What kind of remodeling does HFrEF have?

Answer 38

Eccentric

Question 39

What kind of remodeling does HFpEF have?

Answer 39

Concentric

Question 40

What can happen when there is increased afterload to the right heart?

Answer 40

Pulmonary embolism and chronic pulmonary disease

Question 41

What is the BNP value when you can rule out CHF?

Answer 41

100 or less

Question 42

What is the BNP value when you an rule in CHF?

Answer 42

500 or above

Question 43

What is the NT-proBNP value where you can rule out CHF in patients <50? 50-75? 75?

Answer 43

300 for all

Question 44

What is the NT-proBNP value where you can rule in CHF in patients <50? 50-75? 75?

Answer 44

450 900 1800

Question 45

What are the goals of therapy in HF?

Answer 45

- Reduce preload to diminish congestive symptoms | - reduce afterload to improve cardiac function

Question 46

What is the main side effect of beta blockers?

Answer 46

Bradycardia

Question 47

What should you monitor when placing your patient on an MRA?

Answer 47

Electrolytes, fluid, balance, and renal function (may result in hyperkalemia )

Question 48

What is digoxin and what are these types of medications used for?

Answer 48

An inotropic agent, which are used to improve symptoms and decreased hospitalization rates in symptomatic heart failure. -Also used in patient with concomitant atrial fibrillation

Question 49

How is ADHF managed?

Answer 49

- O2 - Diuretics - Nitro