Heart Failure

Question 1

What are 4 classifications of cardiomyopathy?

Answer 1

Dilated CM, hypertrophic CM, restrictive CM, and arrhythmogenic CM

Question 2

What is the most common cause of HF?

Answer 2

Cardiomyopathy

Question 3

What are the 2 main types of HF?

Answer 3

HFrEF (EF <40%) and HFpEF (EF >40%)

Question 4

Which type of HF is common in older women?

Answer 4

HFpEF (EF >40%)

Question 5

HFrEF is caused by a reduction in

Answer 5

The contractility of the left ventricle (systolic)

Question 6

Neurohormonal overexpression in HF causes activation of

Answer 6

Adrenergic nervous system and renin-angiotensin system

Question 7

HFpEF is associated with

Answer 7

Impairment of ventricular filling and relaxation (diastolic)

Question 8

Activation of the RAAS causes retention of

Answer 8

Sodium and water leading to decreased renal perfusion and increased BUN/Cr

Question 9

What are 6 causes of HF?

Answer 9

Cardiotoxic medications, autoimmune disorders, familial CMO, infiltrative heart disease (amyloidosis), stress cardiomyopathy (Takotsubo), and substance use

Question 10

What are symptoms of HF?

Answer 10

Dyspnea, fatigue, lower extremity edema, JVD, paroxysmal nocturnal dyspnea, SOB with exertion or at rest

Question 11

What is characteristic of amyloidosis?

Answer 11

Protein deposits in organ tissues

Question 12

According to ACC/AHA guidelines, describe the 4 stages of HF

Answer 12

Stage A: at risk for HF
Stage B: pre-HF
Stage C: symptomatic HF
Stage D: advanced HF

Question 13

According to NYHA functional classification, describe the 4 stages of HF

Answer 13

Class I: asymptomatic
Class II: mild
Class III: moderate
Class IV: severe

Question 14

Which disease is an under diagnosed cause of HF?

Answer 14

Amyloidosis

Question 15

Amyloidosis should be considered in patients with

Answer 15

HFpEF, low-voltage EKG, and hypertrophy on echo (but not on EKG)

Question 16

What are diagnostic tests that can be done for HF?

Answer 16

Echo, chest x-ray, EKG, cardiac catheterization, cardiac MRI, PET/CT, and exercise tolerance testing

Question 17

A cardiac MRI would be helpful in ruling out

Answer 17

Amyloidosis or cardiomyopathy

Question 18

BNP and NT-proBNP promote

Answer 18

Vasodilation, diuresis, and regulation of cardiac remodeling

Question 19

What should be assessed for in the physical exam when suspecting HF?

Answer 19

JVD, narrow pulse pressure, apical pulse displacement, S3 gallop (indicates fluid overload), cardiac murmur, adventitious lung sounds, and edema

Question 20

Name 5 differential diagnoses for HF

Answer 20

Mechanical obstruction, COPD, asthma and URI, pleural effusion, pulmonary emboli

Question 21

BNP levels may be increased with

Answer 21

Age, ACS, atrial fibrillation, anemia, COPD, pulmonary HTN, pneumonia, sepsis, valvular disease, and renal dysfunction

Question 22

BNP levels may be decreased with

Answer 22

Obesity

Question 23

What labs should be evaluated when diagnosing HF?

Answer 23

CBC
Serum electrolytes (calcium and magnesium)
Urinalysis
Albumin

Question 24

Which CBC results can exacerbate HF?

Answer 24

Anemia, IDA, or iron overload

Question 25

What electrolyte can be affected with fluid overload and diuretics?

Answer 25

Sodium (decreased)

Question 26

Proteinuria can be evidence of

Answer 26

Renal disease

Question 27

What albumin level may cause edema?

Answer 27

Decreased levels

Question 28

What medications can be used in the treatment of HF?

Answer 28

ACEIs, ARBs, BBs, Hydralazine, nitrates, Aldosterone, diuretics, Digoxin, CCBs, inotropics