Heart Failure

Question 1

HF with a reduced EF is defined as systolic failure with an EF less than or equal to

Answer 1

40%

Question 1

Caused by a variety of pathophysiologic processes in which the heart is unable to pump or fill with an adequate amount of blood to meet the metabolic demands of tissues

Answer 1

Heart Failure

Question 2

HF with a preserved EF with an EF of greater than or equal to

Answer 2

50%

Question 3

Impaired ventricular filling related to impairment of ventricular relaxation

Answer 3

Diastolic heart failure

Question 4

HF with midrange eF with an eF between 41 and 49%

Answer 4

HFmrEF

Question 5

More than ___ people in the US have heart failure

Answer 5

6.5 million

Question 6

What are predisposing factors for HF?

Answer 6

LV dysfunction from CAD, MI, HTN, DM2, metabolic syndrome, physical inactivity, obesity, excessive alcohol intake, and smoking

Question 7

CAD is the most common cause of

Answer 7

chronic HF

Question 8

What are disease states or other factors that can cause HF?

Answer 8

Infections such as pericarditis or systemic bacterial infections, hyperthyroidism, thyrotoxicosis, and pheochromocytoma, thiamine deficiency, protein deficiency, preeclampsia, cardiomyopathy, myocarditis, myasthenia graves, autoimmune diseases, valvular heart disease, rheumatic heart disease, infiltrative disease, sleep apnea, substance abuse, cardio toxicity, idiopathic

Question 9

What happens in heart failure to make up for the heart not pumping effectively?

Answer 9

Cardiac wall thickens with increased muscle mass - Hypertrophy
Chambers enlarge to compensate for increased blood volume - Dilatation
Heart rate increases
Increase in SVR which increases after load
Sodium and water retention

Question 10

What are physical exam findings for LV impairment?

Answer 10

Rales
Crackles, wheezing
Dyspnea
Bilateral infiltrates
S3, S4
Afib
Evidence of pulmonary edema

Question 11

What are physical exam findings for RV impairment?

Answer 11

JVD
Peripheral edema
Hepatomegaly
Ascites
S3, S4

Question 12

What are subjective physical exam findings?

Answer 12

Fatigue, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, tachycardia, edema, nocturia, chest pain, weight gain, anorexia, cardiac cachexia

Question 13

What labs are checked for HF?

Answer 13

ABGs to assess for metabolic and respiratory acidosis, BNP, BMP, magnesium, lipid profile, LFTs, TSH, CXR, ECG, echocardiogram, nuclear stress test

Question 14

What management is used for HF?

Answer 14

Regular exercise 30 minutes 5 days of the week
Smoking cessation
Healthy weight
Discourage alcohol consumption
Agressive BP control
ACEi for all patients with HFrEF who do not have renal insufficiency
ARBs recommended for those who can’t take ACEi
BB is recommended for all patients with HFrEF
Diuretic therapy if patient begins to show evidence of fluid retention
Treat dyslipidemia
Stress management

Question 15

What nonpharmacologic management is used for patients with chronic heart disease?

Answer 15

Sodium restriction 3g
Carbohydrate and caloric restraint teaching
Fluid restriction: less than 1.5-2L is recommended for stage D with hyponatremia
Daily multivitamin use is recommended especially for those on restricted diets or diuretic therapy
Annual flu vaccine and pneumococcal vaccine as appropriate

Question 16

Beta blockers should be used with caution in patients with DM who have

Answer 16

recurrent hypoglycemia, asthma, or resting limb ischemia

Question 17

BB are not recommended in patients who have asthma with

Answer 17

active bronchospasms

Question 18

In patients with or without CAD, prophylactic

Answer 18

ICD placement should be considered if LVEF < 30% or LVEF 31-35% for patients with mild to moderate HF

Question 19

Concomitant ICD placement should be considered in patients undergoing implantation of

Answer 19

biventricular pacing device

Question 20

What is the basic management considerations for patients with HFpEF?

Answer 20

Aggressive BP control, low sodium diet/sodium restriction
Diuretic therapy
BB recommended in patients who have had prior MI, HTN, or Afib
CPAP for OSA

Question 21

What must be monitored inpatient?

Answer 21

Daily weight
I&Os
Daily electrolyte assessment
Monitor for edema, ascites, rales, JVD
Monitor for orthopnea, PND, nocturnal cough, dyspnea, fatigue