Heart Failure I

Question 1

Risk factors for HF

Answer 1

CAD and Atherosclerosis
DM
HTN
Obesity/Metabolic syndrome

Question 2

High output output HF

Answer 2

Heart can’t put out enough blood to meet bodies needs

Question 3

HFrEF

Answer 3

Systolic failure
Under 40% EF
Non-contractile HF

Question 4

HFpEF

Answer 4

Diastolic failure
EF over 50%
Stiff ventricles

Question 5

HFpEF borderline

Answer 5

41-49% EF

Question 6

HFpEF improved

Answer 6

Had HFrEF but now have EF over 40

Question 7

MCC of right sided heart failure

Answer 7

Left sided HF

Question 8

NYHA functional scale and change over time

Answer 8

CAN change over time
I - Heart disease but no limitations
II - Slight limitation, symptoms with ordinary activity
III - Marked limitation and symptoms with less than physical activity
IV - HF symptoms at rest

Question 9

AHA Heart Failure Stages and change over time

Answer 9

CANNOT change over time
A - At risk but no structural disease
B - Have disease but have NEVER had symptoms
C - Structural disease and have or have had symptoms
D - Advanced, refractory disease s/t structural changes

Question 10

Heart Rate of HF

Answer 10

Tachycardia

Question 11

Kidneys in HF

Answer 11

RAAS system
-Vasoconstrict and retain fluid and sodium
Use an ACEI/ARB, Aldosterone antagonist

Question 12

SNS in HF

Answer 12

Pump out epinephrine:
Vasoconstriction
Sodium resorption and water retention
Increase HR and Contractility
Use Vasodilators and BBs

Question 13

Vasodilator for HF

Answer 13

Hydralazine

Question 14

Antidiuretic hormone and HF

Answer 14

Promotes retention of fluid - signaled by baroreceptors
Increased thirst

Question 15

Natriuretic peptides and which is better for labs

Answer 15

ANP and BNP
BNP is BETTER

Question 16

Symptoms of pulmonary congestion

Answer 16

Cough, crackles, rales, increased afterload

Question 17

Preload

Answer 17

How much blood is going IN to the LV

Question 18

Afterload

Answer 18

Resistance from the rest of body to cardiac contraction

Question 19

PE signs of HF

Answer 19

Lower pulse pressure (SBP-DBP)
Pulmonary congestion - dullness and crackles
Pitting edema, ascites
JVD
Precordial palpitations
Displaced PMI
S3 and S4 heart sounds
Weak pulses

Question 20

Edema grade

Answer 20

Depth in mm divided by two

Question 21

Pathognomic sign for LV failure

Answer 21

Pulsus alternans

Question 22

Purpose of lab tests in HF

Answer 22

Determine CAUSE of HF

Question 23

HF EKG

Answer 23

May show an arrhythmia

Question 24

CXR in HF

Answer 24

Cardiomegaly, Pulmonary congestion (moves around, not sick = not infective etiology), Kerley B Lines

Question 25

BNP predictive value

Answer 25

Extremely high negative predictive value - if its not up they don’t have HF
Use to look at exacerbations

Question 26

BNP levels

Answer 26

Under 100 - Very unlikely
100-500 - Possible depending on LV dysfunction
Over 500 - Very likely

Question 27

NT-proBNP levels

Answer 27

Under 300 - Very unlikely
300-1800 - Possible depending on LV dysfunction
Over 1800 - Very likely

Question 28

Other things that can elevate BNP/NT-proBNP

Answer 28

ACS, LVH, A fib, Anemia, Renal failure, Burns, Sepsis
Take in the whole clinical picture

Question 29

Troponin and CHF

Answer 29

Suggests an ongoing myocardial necrosis, may see even w/o ischemic disease process

Question 30

ECHO and CHF

Answer 30

MUST HAVE to visualize ventricles

Question 31

Detection of CAD in CHF

Answer 31

May need to stress testing
May not have chest pain - may consider angiography in some cases