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Board Basics Review > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

1/2 of pts w/ HF have 1 of 2 problems, which are?

A
  1. LV dysfunction = HF w/ reduced ejection fraction (HFrEF)

2. diastolic dysfunction = HF w/ preserved ejection fraction (HFpEF)

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2
Q

what kind of ventricles do pts w/ HFrEF often have?

A

dilated

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3
Q

what kind of ventricles do pts w/ HFpEF often have?

A

normal systolic contraction and normal size ventricles

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4
Q

are sxs for HFrEF and HFpEF different?

A

no, they’re the same

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5
Q

what are the features that increase the likelihood of HF and by how much?

A
  • PND (> 2-fold)

- S3 gallop (11-fold)

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6
Q

what features decrease the likelihood of HF by 50% if absent?

A
  • absence of dyspnea on exertion

- absence of crackles on pulmonary auscultation

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7
Q

what features are independently a/w adverse outcomes of HF, including progression of HF?

A
  • elevated CVP

- S3 gallop

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8
Q

what BNP level is compatible w/ HF?

A

> 500 pg/mL

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9
Q

what BNP level effectively excludes HF?

A

< 100 pg/mL

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10
Q

what are some possible findings on ECG in a pt w/ HF?

A
  • previous MI
  • ventricular hypertrophy
  • arrhythmias
  • conduction abnormalities
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11
Q

what are some possible findings on CXR in a pt w/ HF?

A
  • cardiomegaly
  • pulmonary edema
  • pleural effusion
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12
Q

what are some possible findings on echocardiography in a pt w/ HF?

A
  • EF
  • valvular heart disease
  • HCM
  • regional wall abnormalities suggesting CAD
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13
Q

DON’T BE TRICKED

  • what are unusual causes of HF that should NOT be routinely tested for?
A
  • hemochromatosis
  • Wilson disease
  • MM
  • myocarditis
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14
Q

DON’T BE TRICKED

  • can BNP be used to differentiate between HFrEF and HFpEF?
A

NO

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15
Q

DON’T BE TRICKED

  • should BNP be ordered to monitor HF?
A

NO

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16
Q

DON’T BE TRICKED

  • these factors increase BNP
A
  • kidney failure
  • older age
  • females
17
Q

DON’T BE TRICKED

  • this factor reduces BNP
A
  • obesity
18
Q

how are tx decisions based for HF?

A

NYHA classification of HF

19
Q

NYHA classification of HF:
NYHA functional class

  • class 1
A

structural dz but NO sxs

20
Q

NYHA classification of HF:
NYHA functional class

  • class 2
A

symptomatic; slight limitation of physical activity

21
Q

NYHA classification of HF:
NYHA functional class

  • class 3
A

symptomatic; marked limitation of physical activity

22
Q

NYHA classification of HF:
NYHA functional class

  • class 4
A

INABILITY to perform any physical activity w/o sxs

23
Q

pharmacologic agents for HF:

  • which med should be used in all NYHA classes and reduces mortality?
A

ACEIs

ARBs if ACEI not tolerated

24
Q

pharmacologic agents for HF:

  • in which classes and what scenarios should hydralazine plus nitrates, in addition to standard therapy, be used?
A
  • classes 3 and 4
  • reduce mortality in blacks
  • pts who can’t tolerate ACEIs or ARBs
25
Q

pharmacologic agents for HF:

  • what are the only BBs that should be used and in which classes?
A
  • bisoprolol, metoprolol SUCCINATE, and carvedilol

- all classes, 1 through 4

26
Q

pharmacologic agents for HF:

  • to reduce mortality, which classes should spironolactone be used?
A

classes 2, 3, and 4

27
Q

pharmacologic agents for HF:

  • if spironolactone is not tolerated, what’s the alternative?
A

eplerenone

28
Q

pharmacologic agents for HF:

  • which medication can be used to reduce sxs and length of hospitalization, and in which classes?
A
  • digitalis

- classes 3, and 4

29
Q

pharmacologic agents for HF:

  • when should ICD be placed?
A

ICM and NICM w/ EF of 35% or less

30
Q

pharmacologic agents for HF:

  • when should biventricular pacing be used?
A
  • NYHA classes 2, 3, and 4
  • LVEF of 35% or less
  • or LBBB w/ QRS > 150 ms
31
Q

pharmacologic agents for HF:

  • pts w/ refractory HF sxs
A

cardiac transplant

32
Q

DON’T BE TRICKED

  • when should you NOT start a BB in HF pts?
A

decompensated HF

33
Q

DON’T BE TRICKED

  • can you CONTINUE BBs during decompensated states of HF if pt was previously stable on the BB?
A

YES

34
Q

DON’T BE TRICKED

  • is there any advantage to continuous IV infusion of furosemide vs bolus therapy in decompensated HF?
A

NO

35
Q

DON’T BE TRICKED

  • which meds shouldn’t be prescribed or continued in HF pts bc they worsen HF?
A
  • NSAIDs

- thiazolidinediones

36
Q

DON’T BE TRICKED

  • which meds have NO direct role in tx of systolic HF?
A

CCBs

37
Q

DON’T BE TRICKED

  • which meds may be harmful to pts w/ HF?
A

non-dihydropyridine CCBs (diltiazem or verapamil)

38
Q

DON’T BE TRICKED

  • which med should be avoided in pts w/ changing kidney status or CKD?
A

digoxin

Board Basics Review (24 decks)

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