Heart Failure

Question 1

Etiology of systolic heart failure?

Answer 1

Coronary artery disease (most common)
Hypertension
Cardiomyopathy
Valvular heart disease
Diabetes

Question 2

Etiology of diastolic heart failure?

Answer 2

Hypertension (most common)
Ischemia
Age
Cardiomyopathy
Scarring from MI

Question 3

What is diastolic dysfunction and what happens with the ejection fraction?

Answer 3

Decreased filling due to poor relaxation of ventricles, EF will remain normal and sometimes elevated

Question 4

What is systolic dysfunction and what happens with the ejection fraction?

Answer 4

Decreased contractility with decreased EF, usually <50%

Question 5

What are some key features in left sided heart failure?

Answer 5

SOB (exertional initially -> progressive)
Crackles
Orthopnea
Paroxysmal Nocturnal Dyspnea

Question 6

What are some key features of right sided heart failure?

Answer 6

Primarily signs of fluid retention
Jugular venous distension
Hepatojugular reflex
Pedal Edema
Ascites

Question 7

What are the NYHA classifications?

Answer 7

Class I - asymptomatic

Class II - symptomatic with moderate activity

Class III - symptomatic with mild activity

Class IV - symptomatic at rest

Question 8

What are some cardinal cardiac examination signs?

Answer 8

Parasternal lift - indicating pulmonary hypertension

Enlarged and sustained LV pulse - indicating LV dilation and hypertrophy

Diminished 1st heart sound - suggesting impaired contractility

S3 gallop originating in LV sometimes RV

S4 usually present in diastolic heart failure

Question 9

What levels of NT-proBNP or BNP combined with a normal ECG makes heart failure unlikely?

Answer 9

<300 pg/mL or <100 pg/mL

Question 10

Are there any pharmacological treatments for diastolic dysfunction therapy?

Answer 10

No medications have been proven to reduce mortality, therapy is based on managing symptoms and treating comorbid conditions

Question 11

Treatment for systolic dysfunction?

Answer 11

ACEI/ARBs and BB

Question 12

What should the pharmacological treatment be for stable patients?

Answer 12

BB unless there is a non-cardiac contraindication

Question 13

What pharmacological agent should be considered for patients who remain symptomatic when taking diuretics and ACEI as well as patients with heart failure who are in atrial fibrillation and require rate control?

Answer 13

Digoxin

Question 14

When is resynchronization therapy indicated?

Answer 14

For patients with class II, III, and ambulatory class IV heart failure, EF <35%, and LBBB pattern with QRS duration is 120 msec or more.

Patients with non-LBBB pattern and prolonged QRS may be considered for treatment