Heart Failure

Question 1

What are the risk factors for HF

Answer 1

ischemic heart disease, HTN, DM, smoking, ETOH, hyperlipidemia, family hx, drugs

Question 2

Signs of HF

Answer 2

Lung crackles
Elevated JVP
periferal edema
abdominal jugular reflex (AJR)
heart murmur
3rd hs, 4th hs
displaced apex
HR >100
low BP

Question 3

Symptoms of HF

Answer 3

breathlessness
fatigue
leg swelling 
confusion (prominant in elderly)
orthopenia (SOB lying down)
Paroxysmal nocturnal dyspnea

Question 4

Key ECG finding for HF

Answer 4

Q waves
Left Ventricular hypertrophy
LBBB
tachycardia
afib

Question 5

key chest xray findings of HF

Answer 5

pulmonary edema
Cardiomegaly
pulmonary venous redistribution
pleural effusion

Question 6

BNP values

Answer 6

< 100 pg/ml - HF unlikely
= 100-400 pg/ml - HF possible but other diagnoses need to be considered
> 400 pg/ml - HF likely

Question 7

NT-proBNP

Answer 7

< 300 pg/ml - HF unlikely
= 300-900 pg/ml - HF possible, but other diagnoses need to be considered (age 50-75)
= 300-1800 pg/ml - HF possible, but other diagnoses need to be considered (age > 75)
> 900 pg/ml - HF likely (age 50-75)
> 1800 pg/ml - HF likely (age > 75)

Question 8

ECHO findings

Answer 8

• Decreased left ventricular (LV) ejection fraction
• Increased LV end-systolic and end-diastolic diameter
• LVH
• Wall motion abnormalities and diastolic dysfunction
• Increased RV size and/or RV dysfunction
• Valve dysfunction
• Elevated pulmonary arterial pressures (PAP)

Question 9

what labs/diagnositcs are recommened for all investigations into HF

Answer 9

CBC, creatnine, feritin, TSH, troponin, urinalysis, glucose, chest xray, ECG, - consider BNP after this then echo

Question 10

Goal of medication

Answer 10

Improve survival, symptoms and reduce hospitalizations

Question 11

Medication managment

Answer 11

Lifelong and target doses should be aimed for

Question 12

What are the four staages of HF

Answer 12

NYHA

1. Disease by no symptoms
2. mild, some limitation of activity
3. significant limitation of activity only comfortable at rest
4. Sever limitations at rest

Question 13

When should referal be urgent

Answer 13

after hospitalization for HF
Post MI
Sever with other organ invovlement (hypo, renal disease)

Question 14

When should pt be sent semi urgently

Answer 14

New dx
Mild symptoms with other organ involement (hypo, renal(
stage 2/3 and not improving with medication

Question 15

If LVEF <40% what is the medication protocol

Answer 15

Tripple therapy ACE, BB & MRA

Question 16

What is the target HR

Answer 16

> 70bpm

Question 17

What is the target LVEF

Answer 17

<35%