Heart Failure Assessment

Question 1

What are symptoms of HF?

Answer 1

1. dyspnea
2. orthopnea (SOB when lying down)
3. cough
4. fatigue
5. nausea/ poor appetite
6. addition of pillows

Question 2

What are signs of HF?

Answer 2

1. pulmonary edema/ rales
2. cool extremities
3. cardiomegaly
4. peripheral/ pitting edema
5. venous stasis changes (increase varicose veins)
6. s3 gallop heart sound

Question 3

How are dyspnea, orthopnea, and peripheral edema managed?

Answer 3

loop diuretics

Question 4

How are fatigue, cool extremities, and venous stasis managed?

Answer 4

increase cardiac output by increasing stroke volume with beta-blockers

Question 5

What is synthesized and released from the ventricle due to pressure/ volume overload?

Answer 5

Brain Natriuretic Peptide (BNP)

Question 6

What level of BNP is elevated?

Answer 6

> 100 BUT we need a baseline

Question 7

What can cause a baseline BNP to be elevated?

Answer 7

renal failure / HF

Question 8

How much does BNP need to be reduced for discharge?

Answer 8

decrease 3x

Question 9

How is SCr affected by HF?

Answer 9

1. decreased due to nutritional changes
2. increased due to hypoperfusion (similar to pre-renal AKI)

Question 10

What does hyponatremia indicate in HF?

Answer 10

volume overload and worse outcomes

Question 11

An ejection fraction of ______ if HFrEF

Answer 11

<40%

Question 12

An ejection fraction of _______ if HFpEF

Answer 12

> 60%

Question 13

What NY Heart Classification would someone with no limitation to physical activity be?

Answer 13

I/A

Question 14

What NY Heart Classification would someone with slight limitation (no breaks) to physical activity be?

Answer 14

II/ B

Question 15

What NY Heart Classification would someone with marked limitation (breaks) to physical activity be?

Answer 15

III/C

Question 16

What NY Heart Classification would someone with symptoms as rest be?

Answer 16

IV/D

Question 17

When should Spirinolactone be initiated/ DC for HF?

Answer 17

Initiate: EF < 35% (HFrEF)
D/C: increased K+

Question 18

When should ACE/ARBs be initiated/ DC for HF?

Answer 18

Initiated:
D/C: hypotension, angioedema, increased K+

Question 19

When should Ivabradine be initiated/ DC for HF?

Answer 19

initiated: intolerant/ CI beta blocker AND normal sinus rhythm
D/C: not in normal sinus rhythmm

Question 20

When should Sacubitril/ Valsartan (ENTRESTO) be initiated/ DC for HF?

Answer 20

initiated: all
D/C: increased K+, ACE washout

Question 21

When should loop diuretics be initiated/ DC for HF?

Answer 21

initiated: volume overload
D/C: hypovolemia

Question 22

When should SGLT2 (-) be initiated/ DC for HF?

Answer 22

initiated: all
D/C: DKA, hypovolemiamia

Question 23

What beta-blockers show mortality benefits/ are approved for HFrEF?

Answer 23

Carvedilol
Metoprolol Succinate
Bisoprolol

Question 24

What medications show mortality benefit is AAs with HFrEF?

Answer 24

Hydralazine
Isosorbide Dinitrate

Question 25

What classes of medications show mortality benefits in HFrEF?

Answer 25

1. ACE/ ARB/ Entresto
2. Beta-blockers
3. SGLT2 (-)
4. Mineralcorticoid receptor antagonist

Question 26

How long is the washout period when switching from an ACE to Entresto?

Answer 26

36 hours

Question 27

Does a patient need a washout period when switching from ARB to Entresto?

Answer 27

No it does not affect bradykinin

Question 28

What are adverse effects with hydralazine?

Answer 28

1. SLE (hallmark)
2. rebound tachycardia
3. headache