Heart Failure

Question 1

What’s the classification of HF with preserved EF (HFpEF)?

Answer 1

LVEF ≥ 50%

Question 2

What’s the classification of HF with reduced EF (HFrEF)?

Answer 2

LVEF ≤ 40%

Question 3

what are the main pathophysiology factors that result in HFrEF?

Answer 3

activation of SNS = increased CO
activation of RAAS = increased BP and BV
vasoconstriction = increased BP

Question 4

what is the etiology of HFrEF?

Answer 4

direct injury to myocardium or disease state:
*CAD*
cardiomyopathies
myocarditis
valvular disease
infections

Question 5

what are the risk factors for HF?

Answer 5

age
DM2
HTN
smoking
atherosclerosis
obesity
metabolic syndrome

Question 6

what are the risk factors for HFrEF?

Answer 6

male
LVH
BBB
previous MI
smoking

Question 7

what are the risk factors for HFpEF?

Answer 7

older age
female
HTN
AFib

Question 8

what are the symptoms of congestion?

Answer 8

DOE
paroxysmal nocturnal dyspnea
orthopnea
nocturnal cough
weight fluctuations
edema
hepatojugular reflex
elevated venous pressure

Question 9

what are the symptoms of hypoperfusion?

Answer 9

exercise intolerance
fatigue
decreased mentation (AMS)
cold intolerance

Question 10

what heart sounds can indicate HF?

Answer 10

S3 gallop
enlarged/displaced PMI
right ventricular heave

Question 11

what is the best imaging modality to diagnose HF?

Answer 11

ECHO

Question 12

what labs should be ordered when HF is suspected?

Answer 12

cardiac enzymes (Troponin, BNP, CKMB)
CMP (renal function and potassium)

Question 13

what are the functional classifications of HF?

Answer 13

A - high risk
B - structural heart disease without signs of HF
C - structural heart disease with signs of HF
D - HF requiring specialized interventions

Question 14

what are the treatment objectives in patients with HF?

Answer 14

improve symptoms
improve the quality and duration of life
prevent hospital admission

Question 15

what treatment method results in the best quality of life?

Answer 15

cardiac transplant

Question 16

A patient is diagnosed with HFpEF but doesn’t have HTN. What is your treatment plan?

Answer 16

diuretics ONLY

Question 17

how would you treat a patient with HF that is mildly hypoperfused and mildly congested? (warm-dry)

Answer 17

up-titration of disease-modifying oral therapy

treat comorbidities

Question 18

how would you treat a patient with HF that is mildly hypoperfused but moderately/severely congested? (warm-wet)

Answer 18

vasodilators
diuretics
consider renal replacement therapy

Question 19

how would you treat a patient with HF that is moderately/severely hypoperfused but mildly congested? (cold-dry)

Answer 19

fluid challenge

inotropic agent

Question 20

how would you treat a patient with HF that is moderately/severely hypoperfused and moderately/severely congested? (cold-wet)

Answer 20

consider vasodilator
inotropic agent
vasopressor
diuretics
MCS

Question 21

what is the etiology of cor pulmonale?

Answer 21

develops in response to chronic pulmonary HTN:
parenchymal lung disease
primary pulmonary vascular disease
alveolar hypoxia

Question 22

what is the pathophysiology resulting in cor pulmonale?

Answer 22

pulmonary HTN and increased RV afterload causing altered RV structure and function

Question 23

what are the symptoms of cor pulmonale?

Answer 23

dyspnea

neck: elevated JVP
heart: S3 gallop
lungs: wheezing, crackles
abd: hepatomegaly, hepatojugular reflex & ascites
ext: LE edema and cyanosis

Question 24

how do you diagnose cor pulmonale?

Answer 24

EKG
CXR
2D TTE

Question 25

how do you treat cor pulmonale?

Answer 25

keep SaO2 >/= 90%
diuretics
fluid and Na restriction
IV inotropes 
manage arrhythmias
activity restriction while symptomatic