Heart Failure

Question 1

what are the cardinal clinical symptoms of heart failure?

Answer 1

dyspnea and fatigue

Question 2

what are the cardinal clinical signs of heart failure?

Answer 2

edema and rales

Question 3

what defines heart failure with preserved ejection fraction (HFpEF)?

Answer 3

LVEF >50%

Question 4

what defines heart failure with reduced ejection fraction?

Answer 4

LVEF less than 40%

Question 5

decreased cardiac output leads to activation of what?

Answer 5

activation of SNS and activation of RAAS

Question 6

who is at risk for HFrEF?

Answer 6

male, LVH, bundle branch block, previous MI, smoking

Question 7

who is at risk for HFpEF?

Answer 7

older age, female, hypertension, a fib

Question 8

what type of symptoms are seen in a patient with heart failure?

Answer 8

symptoms of congestion and symptoms of hypoperfusion

Question 9

what are 3 cardiac findings that could be seen in a patient with HF?

Answer 9

an S3 heart sound, enlarged/displaced PMI, and a right ventricular heave

Question 10

when might BNP be elevated with normal volume status?

Answer 10

in patients with advanced age, renal insufficiency, anemia, COPD, pulmonary HTN

Question 11

what imaging modality is used to rule out an intracardiac thrombus or infectious source of HF?

Answer 11

TEE

Question 12

what is an important component in the determination of candidacy for mechanical circulatory support and cardiac transplantation?

Answer 12

cardiopulmonary exercise testing

Question 13

what is the gold standard imaging modality for diagnosing HF?

Answer 13

echocardiography: 2D TTE

Question 14

what does a 2D TTE show in a patient with HFrEF?

Answer 14

reduced LVEF, atrial and ventricular chamber dilation or hypertrophy, valvular dysfunction,

Question 15

what are the two different types of staging/functional classification systems for HF? and what is the main difference between the two?

Answer 15

ACC/AHA and NYHA; ACC/AHA is progressive and increasing mortality. NYHA is a snapshot in time, you can go back and forth

Question 16

generally speaking, how do you improve the symptoms of HF?

Answer 16

diuretics

Question 17

generally speaking, how do you prevent heart remodeling in heart failure?

Answer 17

therapy with ACEi and beta blocker; you can also add an MR antagonist

Question 18

how do you treat HFpEF?

Answer 18

only with diuretics- no other medications have proven to be beneficial; TREAT COMORBIDITIES

Question 19

how do you treat an acutely decompensated HF patient?

Answer 19

you diurese them if they are congested. You improve perfusion if they are hypoperfused

Question 20

what does right sided heart failure develop in response to?

Answer 20

chronic pulmonary HTN resulting from parenchymal lung disorders, primary pulmonary vascular diseases, or conditions leading to alveolar hypoxia (COPD and chronic bronchitis)

Question 21

how might a patient present with cor pulmonale?

Answer 21

systemic congestion- elevatedJVP, LE edema

Question 22

what might an EKG show on a patient with cor pulmonale?

Answer 22

signs of pulmonary HTN: right axis deviation, RV hypertrophy

Question 23

is a 2D TTE helpful in cases of cor pulmonale?

Answer 23

not as much as left sided heart failure: it can be difficult to evaluate due to the severe lung disease