Heart Failure CBM

Question 1

which is the most common cause of heart failure in the developed world?

Answer 1

Ischemic cardiomyopathy

Question 2

List 4 causes of cardiomyopathy

Answer 2

ischemic
myocarditis
significant valvular heart disease
infiltrative diseases including amyloidosis and sarcoidosis
alcohol (typically requires six or more drinks per day)
chemotherapeutic agents such as anthracyclines (e.g. doxorubicin)
autoimmune causes such as collagen vascular disease
tachycardia-induced (e.g. prolonged uncontrolled atrial fibrillation)
idiopathic (no clear aetiology identified)

Question 3

What are the classes of NYHA classification? What is the predicted 5 year survival of NYHA class IV?

Answer 3

I - no limitation of physical activity
II - symptoms with regular activity, comfortable at rest
III - symptoms with less than ordinary activity
IV - symptoms at rest

60%

Question 4

List 5 pharmacologic agents for management of dyspnea in heart failure

Answer 4

1. Optimization of HF therapy (BB, ARB, ACEI, diuretics, mineralcorticoid antagonists)
2. opioids
3. diuretics
4. benzodiazepines
5. inotropic agents
6. ?long acting nitrates

Question 5

What are the Canadian Cardiovascular Society recommendations for CRT pacing:

Answer 5

for patients in sinus rhythm with:

(1) NYHA class II, NYHA class III, or ambulatory NYHA class IV heart failure symptoms;
(2) an ejection fraction of ≤35%;
(3) LBBB with a QRS duration of ≥130 ms.

The guidelines go on to state that CRT pacing can be considered for patients in permanent atrial fibrillation who are otherwise candidates for this therapy.

Question 6

List 5 triggers for discussion about CRT-ICD deactivation? How many lives are saved per 100 over 5 years with ICD implantation?

Answer 6

• prior to implantation
• annual heart failure reviews
• after major milestones
• when the end of life appears to be approaching
• life-threatening comorbidities
• patient request
• situations in which an ICD is unlikely to increase life expectancy

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