Heart Failure

Question 1

Signs and symptoms of HF

Answer 1

• exertional dyspnea, paroxysmal nocturnal dyspnea, orthopnea, peripheral edema
• elevated JVP, S3, crackles on pulmonary, peripheral edema, +/- ascities

Question 2

HF compensatory mechanisms

Answer 2

• Heart: 1. dilates 2/2 increase in preload due to frank-starling mechanism, 2. myocyte hypertrophy to reduce wall stress but ends up reducing compliance
• Increase RAAS -> aldo inc fluid retention, angiotensin II inc BP and stimulates thirst, increase in epi and nor-epi for BP, HR, and contractility (cardiac output)
• all designed to improve BP but end up making worse

Question 3

HFpEF Etiology

Answer 3

-etiology: hypertension, aging, obesity, DM, CAD

Question 4

HFrEF Etiology

Answer 4

-CAD, myocarditis, valvular heart disease, infiltrative process, and HTN

Question 5

Screening, HF

Answer 5

-Screening: BNP, NT-pro BNP usually when dyspneic

Question 6

HF presentation

Answer 6

• usually volume overload, and normal cardiac output

- also volume overload and low cardiac output (cardiogenic shock)

Question 7

Cardiogenic shock

Answer 7

-cool extremities, AMS, low pulse pressure (also seen with AS and cardiac tamponade)

Question 8

HF induced hepatopathy

Answer 8

-caused by vascular congestion

Question 9

Left sided HF Physical Exam

Answer 9

• elevated JVP and orthopnea usually = elevated PCWP. Most specific exam finding
• ESCAPE Trial

Question 10

HF Diagnosis

Answer 10

• EKG for ischemia/arrythmia
• BNP (differentiate from pulmonary causes) usually >400 with cardiac etiology, pulm <100
• CXR
• TSH (for reversible HF)
• BMP
• ECHO (regional WMA - CAD, or cardiac amyloid in myocardium)
• +/- cath if CAD concern

Question 11

HF Classification

Answer 11

• Functional: NYHA
• I: no limitation
• II: slight limitation of physical activity
• IIIA: sx with less than ordinary activity
• IIIB: sx with minimal exertion
• IV: Unable to carry on any physical activity without symptoms
• ACC/AHA HF Stages:
• A: At risk for HF w/o structural changes (DM, CAD, HTN, vasular dz)
• B: Structural (reduced EF, LVH, LAE/RAE) but without HF sx
• C: Structural w/HF sx
• D: Refractory HF requiring advanced intervention (biventricular pacemaker, LVAD, transplant)