Heart Failure

Question 1

Clinical signs and symptoms of HF

Answer 1

dyspnea, fatigue, edema and rales

Question 2

HF where ejection fraction is >50%

Answer 2

HFpEF

*preserved EF

Question 3

HF where ejection fraction is <40%

Answer 3

HFrEF

*reduced EF

Question 4

Sudden onset of HF symptoms

Answer 4

ADHF

*acute decompensated HF

Question 5

Altered RV structure/function in the context of chronic lung disease

Answer 5

Cor pulmonale

Question 6

HFrEF pathophysiology

Answer 6

Myocardial injury lead to decreased CO, which activates SNS and RAAS, leading to increased HR, blood pressure (vasoconstriction) and blood volume

• causes eccentric LV hypertrophy, systolic dysfunction, reduced LV EF
• HFpEF less well understood

Question 7

Shared risk factors for HFrEF and HFpEF

Answer 7

Age
DM2
Smoking
HTN
Atherosclerosis
Obesity
Metabolic syndrome

Question 8

The following risk factors are specific for which type of HF?

Male
LVH
BBB
Previous MI
Smoking

Answer 8

HFrEF

*dilated hypertrophic LV

Question 9

The following risk factors are specific for which type of HF?

Female
Old
HTN
Afib

Answer 9

HFpEF

*concentric hypertrophic LV

Question 10

Clinical presentation for Left heart failure

Answer 10

• Symptoms of congestion (pulmonary)
• Symptoms of hypoperfusion (cyanosis, fatigue, exercise intolerance)

*also be sure to ID risk factors for HF

Question 11

Diagnostic features of HF on physical exam

Answer 11

• Vital signs
• Assessment of congestion (wet/dry) and perfusion (warm/cold)
• S3 on auscultation
• Displaced MPI on auscultation

Question 12

Diagnostic imaging for HF

Answer 12

ECG (assess rhythm, ischemia, conduction)

CXR (pulm congestion, heart enlargement)

Echo (assess LVEF, chamber remodeling, valves, pericardial disease, etc.)

Question 13

Diagnostic labs for HF

Answer 13

Check K (hypokalemia in HF due to RAAS)
Check BNP (sensitive, normal BNP rules out HF)

Question 14

Staging/ Functional Classifications of HF

Which scale describes progressive, demonstrating increasing mortality?

Answer 14

ACCF/AHA

*staging HF associated with mortality

Question 15

Staging/ Functional Classifications of HF

Which scale provides a snapshot of a pts functional classification in HF?

Answer 15

NYHA

*functional classifications based on ADLs

Question 16

In the treatment/management of HFrEF, what drugs help with symptom relief?

Answer 16

Diuretics

*alleviate congestion

Question 17

In the treatment/management of HFrEF, what drugs help prevent remodeling?

Answer 17

ACEi, B-blockers

*MR antagonist added if LVEF not improved with ACEi and B-blockers

Question 18

What is the only evidence-based medication treatment for HFpEF?

Answer 18

Diuretics

Question 19

In the treatment/management of ADHF, what can be used to treat hypoperfusion (cold)?

cold = hypoperfused
wet = congested

Answer 19

Fluid challenge and/or inotropic agents

*goal is to improve perfusion!

Question 20

In the treatment/management of ADHF, what can be used to treat congestion (wet)?

cold = hypoperfused
wet = congested

Answer 20

Vasodilators, diuretics, dialysis

*goal is to relieve congestion

Question 21

Pathophysiology of cor pulmonale

Answer 21

Pulmonary HTN = increased RV afterload, leads to alterations in RV structure and function

Question 22

Clinical presentation for cor pulmonale

Answer 22

Systemic congestion (LE edema, increased abdominal girth (ascites)
Elevated JVP
S3 on auscultation
Pulmonary disorder on auscultation (wheezes, rales)
Hepatomegaly, hepatojugular reflux
LE edema and cyanosis

Question 23

Diagnostic imaging for cor pulmonale

Answer 23

ECG: signs of pulm HTN (right axis deviation, RV hypertrophy)

CXR: enlargement of pulmonary vessels

Question 24

Treatment and management of cor pulmonale

Answer 24

Maintain O2 >90%
Optimize volume status: Diuretics, Na restriction
IV inotropes
Restrict activity while symptomatic
Palliative care

Question 25

Prevention of HF

Answer 25

Treat underlying conditions that lead to HF!

*HTN, hyperlipidemia, DM, obesity, smoking

• Stage A: primary prevention (stop CVD from happening)
• Stage B: secondary prevention (stop HF from getting worse)