Heart Failure

Question 1

Types of categorization of heart failure

Answer 1

HFpEF = HF w/ preserved ejection fraction

• “diastolic Heart failure”
• > 50% EF

HFrEF = HF w/ reduced ejection fraction

• “systolic Heart failure”
• <40% EF

CHF = chronic heart failure/congestive heart failure
R or L HF

Question 2

AHA Stages of heart failure

Answer 2

Stage A: high risk of HF without structural heart disease or symptoms of HF

Stage B: structural heart disease without signs/symptoms of HF

Stage C: structural heart disease w/ prior or current symptoms of HF

Stage D: refractory HF that always requires specialized interventions (surgery)

Question 3

NYHA functional classification

Answer 3

Class 1: patients w/ heart disease without limitation of physical activity
- NO SYMPTOMS

Class 2: patients w/ heart disease resulting in slight limitation of physical activity with symptoms only appearing w/ strenuous activity (none at rest)

Class 3: patients w/ heart disease resulting in marked limitation of physical activity. Symptoms arise with mild-moderate activity but no symptoms at rest

Class 4: Patients w/ heart disease resulting in inability to carry on any physical activity without severe symptoms. Symptoms are present at rest.

• symptoms include fatigue and dyspnea and angina*

Question 4

What stages and classes are homologous?

Answer 4

B = 1

C = can be 1-4

D = 4

Question 5

Cardinal signs/symptoms for right sided heart failure

Answer 5

Peripheral edema (especially in the lower extremities)

Pitting edema

Ascites

RUQ w/ hepatomegaly

JVD

S3 heart sounds

Anasarca (generalized edema)

Question 6

Cardinal signs/symptoms for left-sided heart failure

Answer 6

Fluid backup from heart-> lungs

Causes:

• dyspena
• rales in lungs
• pulmonary edema

Pulses alternans is almost 100% diagnostic for left sided heart failure, but it is only present in cardiac effusions

Question 7

Common heart failure symptoms regardless of sided

Answer 7

Dyspena

Orthopnea

Fatigue

Weakness

Anorexia and cachexia (only in chronic)

Question 8

Clinical tests/evaluations for heart failure

Answer 8

1) ECG:
HFrEF = low QRS complex on ecg

HFpEF =. Normal ECG

2) CBC, CMP and troponin

3) BNP levels
- HF has >400 pg/mL (this tells you that the dyspnea is caused by HF)
- if <100 pg/mL, is almost never heart failure

4) Chest radiography
5) Echo

Question 9

Major criteria for heart failure

Answer 9

Any of the following symptoms

• paroxysmal nocturnal dyspnea
• orthopnea
• elevated JVD
• S3 sound
• pulmonary edema or cardiomegaly
• cardiac cachexia (w/ treatment)

2 major = HF

Question 10

Minor criteria for heart failure

Answer 10

Any of the following symptoms

• Bilateral leg edema
• Nocturnal cough
• Dyspnea on ordinary
• Hepatomegaly
• Pleural effusion
• tachycardia
• cardiac cachexia (w/out treatment)

1 major and 1 minor = HF

Question 11

What is the fluid restriction management for refractory HF?

Answer 11

1.5-2L per day max

Question 12

Treatment of typical acute decompression w/ HF

Answer 12

If hypertensive causes
- use vasodilators

If volume overload causes
- use diuretics

Question 13

Treatment of pulmonary edema acute decomposition

Answer 13

Combo of the following:

• Opiates
• Vasodilator
• Diuretics

Question 14

Treatment of low output acute decomposition

Answer 14

A combo of

• vasodilators
• inotropic therapy (only in low BP)
• Hemodynamic monitoring