Heart Failure Flashcards
1/2 of pts w/ HF have 1 of 2 problems, which are?
- LV dysfunction = HF w/ reduced ejection fraction (HFrEF)
2. diastolic dysfunction = HF w/ preserved ejection fraction (HFpEF)
what kind of ventricles do pts w/ HFrEF often have?
dilated
what kind of ventricles do pts w/ HFpEF often have?
normal systolic contraction and normal size ventricles
are sxs for HFrEF and HFpEF different?
no, they’re the same
what are the features that increase the likelihood of HF and by how much?
- PND (> 2-fold)
- S3 gallop (11-fold)
what features decrease the likelihood of HF by 50% if absent?
- absence of dyspnea on exertion
- absence of crackles on pulmonary auscultation
what features are independently a/w adverse outcomes of HF, including progression of HF?
- elevated CVP
- S3 gallop
what BNP level is compatible w/ HF?
> 500 pg/mL
what BNP level effectively excludes HF?
< 100 pg/mL
what are some possible findings on ECG in a pt w/ HF?
- previous MI
- ventricular hypertrophy
- arrhythmias
- conduction abnormalities
what are some possible findings on CXR in a pt w/ HF?
- cardiomegaly
- pulmonary edema
- pleural effusion
what are some possible findings on echocardiography in a pt w/ HF?
- EF
- valvular heart disease
- HCM
- regional wall abnormalities suggesting CAD
DON’T BE TRICKED
- what are unusual causes of HF that should NOT be routinely tested for?
- hemochromatosis
- Wilson disease
- MM
- myocarditis
DON’T BE TRICKED
- can BNP be used to differentiate between HFrEF and HFpEF?
NO
DON’T BE TRICKED
- should BNP be ordered to monitor HF?
NO
DON’T BE TRICKED
- these factors increase BNP
- kidney failure
- older age
- females
DON’T BE TRICKED
- this factor reduces BNP
- obesity
how are tx decisions based for HF?
NYHA classification of HF
NYHA classification of HF:
NYHA functional class
- class 1
structural dz but NO sxs
NYHA classification of HF:
NYHA functional class
- class 2
symptomatic; slight limitation of physical activity
NYHA classification of HF:
NYHA functional class
- class 3
symptomatic; marked limitation of physical activity
NYHA classification of HF:
NYHA functional class
- class 4
INABILITY to perform any physical activity w/o sxs
pharmacologic agents for HF:
- which med should be used in all NYHA classes and reduces mortality?
ACEIs
ARBs if ACEI not tolerated
pharmacologic agents for HF:
- in which classes and what scenarios should hydralazine plus nitrates, in addition to standard therapy, be used?
- classes 3 and 4
- reduce mortality in blacks
- pts who can’t tolerate ACEIs or ARBs
pharmacologic agents for HF:
- what are the only BBs that should be used and in which classes?
- bisoprolol, metoprolol SUCCINATE, and carvedilol
- all classes, 1 through 4
pharmacologic agents for HF:
- to reduce mortality, which classes should spironolactone be used?
classes 2, 3, and 4
pharmacologic agents for HF:
- if spironolactone is not tolerated, what’s the alternative?
eplerenone
pharmacologic agents for HF:
- which medication can be used to reduce sxs and length of hospitalization, and in which classes?
- digitalis
- classes 3, and 4
pharmacologic agents for HF:
- when should ICD be placed?
ICM and NICM w/ EF of 35% or less
pharmacologic agents for HF:
- when should biventricular pacing be used?
- NYHA classes 2, 3, and 4
- LVEF of 35% or less
- or LBBB w/ QRS > 150 ms
pharmacologic agents for HF:
- pts w/ refractory HF sxs
cardiac transplant
DON’T BE TRICKED
- when should you NOT start a BB in HF pts?
decompensated HF
DON’T BE TRICKED
- can you CONTINUE BBs during decompensated states of HF if pt was previously stable on the BB?
YES
DON’T BE TRICKED
- is there any advantage to continuous IV infusion of furosemide vs bolus therapy in decompensated HF?
NO
DON’T BE TRICKED
- which meds shouldn’t be prescribed or continued in HF pts bc they worsen HF?
- NSAIDs
- thiazolidinediones
DON’T BE TRICKED
- which meds have NO direct role in tx of systolic HF?
CCBs
DON’T BE TRICKED
- which meds may be harmful to pts w/ HF?
non-dihydropyridine CCBs (diltiazem or verapamil)
DON’T BE TRICKED
- which med should be avoided in pts w/ changing kidney status or CKD?
digoxin
