Exam 2: HF

Question 1

Definition of HF

Answer 1

failure of the heart to pump blood at a rate commensurate with the requirements of the metabolizing tissues

Question 2

Most common cause of HFrEF

Answer 2

CAD (Ischemic Dilated CM)

Other causes: HTN, valvular Dz, cardiomyopathies

Question 3

Definition of HFrEF

Answer 3

HF symptoms with EF < 40%

Question 4

Impairment in Cardiac Function: HFrEF

Answer 4

Systolic dysfunction: decreased contractility

Question 5

HFpEF Definition

Answer 5

HF symptoms with EF > 50%

Question 6

Impairment in Cardiac Function

Answer 6

diastolic dysfunction: impairment in ventricular relaxation/filling

Question 7

Cause of HFpEF

Answer 7

HTN is most common cause

Question 8

Determinants of LV Performance (Stroke Volume)

Answer 8

Preload: venous return, LVEDV

Myocardial Contractility: force generated at any given LVEDV

Afterload: Aortic impedance and wall stress

Question 9

Medications that Reduce Preload (move left on FS Curve)

Answer 9

diuretics
nitrates

Question 10

Medications that increase cardiac output (move up on FS Curve)

Answer 10

ACE inhibitors
positive inotrope

Question 11

Factors precipitation or worsening HF

Answer 11

lack of compliance

Question 12

Drug Induced HF

Answer 12

drugs that reduce contractility (inotropes)

drugs that cause direct cardiac toxicities

drugs that cause fluid overload

Question 13

Natriuetic Peptides Labs

Answer 13

BNP > 35 pg/mL

NT-proBNP >125 pg/mL

Question 14

NYHA Class 1

Answer 14

patients with cardiace disease but without limitations of physical activity

asymptomatic disease

Question 15

NYHA Class II

Answer 15

patients with cardiac disease resulting in slight limitations of physical activity

Question 16

NYHA Class III

Answer 16

patients with cardiac disease resulting in limitations of physical activity

Question 17

NYHA Class IV

Answer 17

patients with cardiac disease resulting in inability to carry on any physical activity without discomfort

Question 18

AHA Stage A

Answer 18

high risk of developing HF but no identified structural or functional abnormalities of the heart and have never shown signs or symptoms of HF

Question 19

AHA Stage B

Answer 19

Structural heart disease that is strongly associated with HF but no signs or symptoms of HF

Class I

Question 20

AHA Stage C

Answer 20

current or prior symptoms of HF associated with underlying structural heart disease

class II and III

Question 21

AHA Stage D

Answer 21

advanced structural heart disease and marked symptoms of HF at rest despite max medical therapy and who require specialized interventions

Question 22

General Measures: Exercise

Answer 22

dynamic exercise to increase HR 60-80% of maximum for 20-60 minutes 3-5 times/week

Question 23

General Measures: Sodium

Answer 23

intake should be restricted to 2-3 grams/day as possible

Question 24

General Measures: Alcohol

Answer 24

patients with EtOH induced HF should totally abstain

No more than 2 or 1 drink per day

Question 25

General Measures: Misc

Answer 25

weight monitoring
general education
smoking cessation
immunizations
electrolytes
thyroid disease mgnt
herbal products

Question 26

Drug Therapy Strategies: Diuretics/SGLT2i

Answer 26

reduce intravascular volume

Question 27

Drug Therapy Strategies: positive inotropes

Answer 27

increase myocardial contractility

Question 28

Drug Therapy Strategies: ACEi, vasodilators, SGLT2i

Answer 28

decrease ventricular afterload

Question 29

Drug Therapy Strategies: ARNis, BB, ACEi/ARBs, MRAs, SGLT2i

Answer 29

neurohormonal blockade

Question 30

GDMT for Stage A

Answer 30

if ASCVD present: ACEi/ARB

Question 31

GDMT for Stage B

Answer 31

if previous MI or asymptomatic rEF: ACEi/ARB or BB

Question 32

GDMT for Stage C

Answer 32

ARNI/ACE/ARB (ARNI preferred)
GDMT BB
Aldosterone Antagonist
SGLT2i

loop for symtpomatic only

Question 33

Place of Therapy: ISDN/Hydralazine

Answer 33

Class I Evidence A: if black and persistently symptomatic on GDMT

Class IIa Evidence B: if ARNI/ACE/ARB intolerant

Question 34

Place of Therapy: Digoxin

Answer 34

Class IIa Evidence B: if persistently symptomatic on GDMT

Question 35

Place in Therapy: Ivabrandine

Answer 35

NYHA Class II-III symptoms in NSR and HR≥ 70 bpm on maximally tolerated BB

Question 36

Diuretics: Place in Therapy

Answer 36

All HF patients with signs/symptoms of fluid retention should be managed with diuretics

reduce hospitalizations but do not have effect on mortality or natural progression of HF