Heart Failure Medications and Indications

Question 1

NYHA I

Answer 1

Structural disease but no symptoms

Question 2

NYHA II

Answer 2

Symptomatic; slight limitation of physical activity

Question 3

NYHA III

Answer 3

Symptomatic; marked limitation of physical activity

Question 4

NYHA IV

Answer 4

Inability to perform any physical activity without symptoms

Question 5

Beta blocker

Answer 5

NYHA class I-IV to reduce mortality

Question 6

ACEI/ARB

Answer 6

For all stages of HF to reduce mortality

Question 7

Aldosterone antagonist (spironolactone or eplerenone)

Answer 7

For NYHA class III-IV HF to reduce mortality

Question 8

Hydralazine plus nitrates

Answer 8

NYHA class III-IV and EF <40% in black and select nonblack patients (low output syndrome, hypertension) to reduce mortality

Also for patients who cannot tolerate ACEI/ARB

Question 9

Diuretics

Answer 9

To improve symptoms of bolume overload

Question 10

Valsartan-sacubitril

Answer 10

Substitute for an ACEI/ARB in HFrEF (NYHA II-III) in patients who have tolerated ACEI/ARB (no symptoms of hypotension)

Question 11

Digitalis

Answer 11

Used predominantly in patients who continue to experience symptoms despite GDMT

Question 12

Ivabradine

Answer 12

EF <35% who are in sinus rhythm with a heart rate >70/min

Question 13

ICD

Answer 13

EF <35% and NYHA II-III OR with EF <30% and NYHA I (after GDMT)

Question 14

Cardiac resynchronization therapy

Answer 14

NYHA class II-IV, EF <35%, AND LBBB with QRS >150ms

Question 15

Cardiac transplant/LVAD

Answer 15

Patients with refractory HF symptoms despite maximal medical therapy

Question 16

Exercise training

Answer 16

Recommended in all patients with newly diagnosed HF

Question 17

Nondihydropyridine CCVs (dilt or verapamil) may be ____ to patients with HF

Answer 17

Harmful

Question 18

Do not prescribe NSAIDS or thiazolidinediones because they _____ HF.

Answer 18

worsen

Question 19

Continuous IV therapy provides ______ to bolu therapy in decompensated HF.

Answer 19

No benefit

Question 20

Do NOT begin ____ in patients with decompensated HF.

Answer 20

BB

Question 21

BNP _____ effectively rules-out HF as a cause of acute dyspnea.

Answer 21

<100pg/mL

Question 22

BNP ____ is compatible with HF.

Answer 22

> 400

Question 23

Heart sound associated with HF

Answer 23

S3