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ESC GUIDELINES > HF guidelines > Flashcards

HF guidelines Flashcards

1
Q

TAFAMIDIS

A

is recommended in patients with genetic testing proven hTTR-CA, wtTTR-CA who are NYHA I or II to reduce symptoms, CV hospitalization, motality

CLASS I

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2
Q

Right heart catheterization should be considered in patients where HF is thought to be due to constrictive pericarditis, restrictive cardiomyopathy, congenital heart disease, and high output states.

A

class IIa

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3
Q

Right heart catheterization may be considered in selected patients with HFpEF to confirm the diagnosis.

A

CLASS IIb

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4
Q

Dapagliflozin or empagliflozin are recommended for patients with HFrEF to reduce the risk of HF hospitalization and death.

A

CLASS I

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5
Q

Vericiguat

A

NYHA class II-IV who had worsening HF depsite treatment with 4 pillars

class IIb

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6
Q

HFmrEF

A

ACEI, ARB, BB, MRA, ENTRESTO

class IIb

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7
Q

Influenza and pneumococcal vaccinations should be considered in order to prevent HF hospitalizations.

A

class IIa

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8
Q

It is recommended that patients hospitalized for HF be carefully evaluated to exclude persistent signs of congestion before discharge and to optimize oral treatment.

A

class I

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9
Q

it is recommended that evidence-based oral medical treatment be administered before discharge.

A

class I

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10
Q

An early follow-up visit is recommended at 12 weeks after discharge to assess signs of congestion, drug tolerance, and start and/or uptitrate evidence-based therapy.

A

class I

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11
Q

Long-term treatment with an oral anticoagulant should be considered for stroke prevention in AF patients with a CHA2DS2-VASc score of 1 in men or 2 in women.

A

class IIa

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12
Q

revascularization in CCS and HF

A

CABG should be considered as the first-choice revascularization strategy, in patients suitable for surgery, especially if they have diabetes and for those with multivessel disease.

class IIa

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13
Q

In LVAD candidates needing coronary revascularization, CABG should be avoided, if possible.

A

class IIa

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14
Q

PCI may be considered as alternative to CABG, based on Heart Team evaluation, considering coronary anatomy, comorbidities, and surgical risk.

A

class IIb

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15
Q

Coronary revascularization may be considered to improve outcomes in patients with HFrEF, CCS, and coronary anatomy suitable for revascularization, after careful evaluation of the individual risk to benefit ratio, including coronary anatomy (i.e. proximal stenosis >90% of large vessels, stenosis of left main or proximal LAD), comorbidities, life expectancy, and patient’s perspectives

A

class IIb

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16
Q

Percutaneous edge-to-edge mitral valve repair should be considered in carefully selected patients with secondary mitral regurgitation, not eligible for surgery and not needing coronary revascularization, who are symptomatic despite OMT and who fulfil criteria to achieve a reduction in HF hospitalizations.

A

class IIa

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17
Q

Percutaneous edge-to-edge mitral valve repair may be considered to improve symptoms in carefully selected patients with secondary mitral regurgitation, not eligible for surgery and not needing coronary revascularization, who are highly symptomatic despite OMT and who do not fulfil criteria for reducing HF hospitalization.

A

class IIb

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18
Q

SGLT in HF and DM

A

recommended for pts with T2DM at risk of CV events

and for pts with HF and T2DM

class I

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19
Q

DPP4 saxagliptin

A

class III in HF

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20
Q

IV iron

A

if EF 50% and ferritin less than 100 or 100-299 with TSAT less than 20%

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21
Q

EPO in HF

A

Class III

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22
Q

cancer pts on antrhracycline

A

ACEI and BB (carvedilol) if developed LV systolic dysfunction (10% dec. in EF to a value lower than 50%)

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23
Q

diagnostic algorithm of HF 1

A

risk factors + sign and symptoms + ECG

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24
Q

diagnostic algorithm HF 2

A

NT pro BNP 125
BNP 35

in AF X3
NT pro BNP 365
BNP 105

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25
Q

diagnostic algorithm HF 3

A

ECHO

less than 40 = HFrEF
41-49 = HFmrEF
more than 50 = HFpEF

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26
Q

recommended diagnostic tests in all HF pts

A

BNP, pro BNP
ECG
ECHO
CXR
labs: CBC, urea, creat, electrolytes, thyroid, HBA1c, iron profile (ferritin, TSAT)

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27
Q

cardiac causes of elevated NPs

A

HF
ACS
PE
myocarditis
LVH
HCM, RCM
VHD
CHD
tachyarrythmias
heart contusion
cardioversion
ICD shock
surgery
PHTN

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28
Q

non cardiac causes of elevated NPs

A

advanced age
ischemic stroke
SAH
CKD
liver cirrhosis and ascitis
paraneoplastic syndrome
COPD
severe infection (pnuemonia, sepsis)
severe burns
anemia
severe metabloic and hormonal abnormalities (thyrotoxicosis, diabetic ketosis)

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29
Q

what decrease NPs ?

A

obesity

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30
Q

CMR

A

recommended for the assessment of myocardial structure and function in those with poor echocardiogram acoustic windows.

class I

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31
Q

CMR

A

recommended for the characterization of myocardial tissue in suspected infiltrative disease, Fabry disease, inflammatory disease (myocarditis), LV non-compaction, amyloid, sarcoidosis, iron overload/haemochromatosis.

class I

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32
Q

CMR with LGE

A

DCM to distinguish between ischaemic and non-ischaemic myocardial damage.

class IIA

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33
Q

Invasive coronary angiography

A

recommended in patients with angina despite pharmacological therapy or symptomatic ventricular arrhythmias.

class I

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34
Q

Invasive coronary angiography in HFrEF

A

with an intermediate to high pre-test probability of CAD and the presence of ischaemia in non-invasive stress tests.

class IIb

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35
Q

CTCA

A

is considered in low to intermediate pre test probability of CAD or those with equivocal non invasive stree tests to rule out CAD

class IIa

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36
Q

Non-invasive stress imaging (CMR, stress echocardiography, SPECT, PET)

A

may be considered for the assessment of myocardial ischaemia and viability in patients with CAD who are considered suitable for coronary revascularization

class IIb

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37
Q

Exercise testing

A

may be considered to detect reversible myocardial ischaemia and investigate the cause of dyspnoea

class IIb

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38
Q

Cardiopulmonary exercise testing

A

is recommended as a part of the evaluation for heart transplantation and/or MCS

class I

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39
Q

Cardiopulmonary exercise testing

A

should be considered to optimize prescription of exercise training.

class IIa

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40
Q

Cardiopulmonary exercise testing

A

should be considered to identify the cause of unexplained dyspnoea and/or exercise intolerance

class IIa

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41
Q

Right heart catheterization

A

recommended in patients with severe HF being evaluated for heart transplantation or MCS.

class I

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42
Q

Right heart catheterization

A

should be considered in patients where HF is thought to be due to constrictive pericarditis, restrictive cardiomyopathy, congenital heart disease, and high output states.

class IIa

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43
Q

Right heart catheterization

A

should be considered in patients with probable pulmonary hypertension, assessed by echo in order to confirm the diagnosis and assess its reversibility before the correction of valve/structural heart disease.

class IIa

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44
Q

right side heart cath to confirm diagnosis of HFpEF

A

class IIb

45
Q

endomyocardial biopsy

A

considered in patients with rapidly progressive HF despite standard therapy when there is a probability of a specific diagnosis, which can be confirmed only in myocardial samples

class IIa

46
Q

EF less than 35 with QRS less than 130

A

ICD non ishcemic class IIA
ischemic class I

47
Q

LVEF less than 35 and QRS more than 130

A

CRT D/P
QRS 130-150 class IIa
QRS more than 150 class I

48
Q

MRA

A

coution in impaired renal function and K conc more than 5

49
Q

Ivabradine

A

syptomatic pt with LVEF less than 35 and HR more than 70 despite treatment with BB, ACEI, MRA

class IIa

50
Q

Ivabradine

A

symptomatic patients with LVEF <_35%, in SR and a resting heart rate >_70 b.p.m. who are unable to tolerate or have contraindications for a beta-blocker to reduce the risk of HF hospitalization and CV death. Patients should also receive an ACE-I (or ARNI) and an MRA.

class IIa

51
Q

Verciguat

A

class IIb in NYHA II-IV who had worsening HF despite treatment with 4 pillars

52
Q

hydralazine and ISD

A

in black patients with LVEF less than 35 or with LVEF less than 45 + dilated LV in NYHA III-IV despite 4 pillars

class IIA

53
Q

hydralazine and ISD

A

in pt with symptomatic HFrEF who cant tolerate any of ACEI, ARB, ARNI

54
Q

Digoxin

A

considered in patients with SR and HFrEF symptomatic on 4 pillars

55
Q

ACEI doses
captopril
ramipril
enalapril
lisdinopril

A

capto 25 1X3 to 50 1X3
enalapril ramipril (2.5 1X2) to rami 5 1X2 enala 10-20 1X2
lisino 2.5 to 5 once to 20-35 once

56
Q

entresto does

A

50 1X2 start dose
100 1X2 target dose

57
Q

BB doses

A

biso (concor) 1.25 to 10 mg once
carvid 6.125 to 25 twice
metoprolol (selekonzoc) 12.5-25 to 200 once
nevilob 1.25 to 10 mg once

58
Q

MRA doses

A

spironolactone and eplerenone 25mg to 50 mg once

59
Q

SGLT2

A

Dapa and Empa 10 mg once a start and a target

60
Q

DOSES
candesartan
losartan
valsartan

A

cande 4 to 32 mg once
losa 50 to 150 mg once
valsartan 40 to 160 mg twice

61
Q

DOSES
vericiguat
digoxin
hydralazine/ISM

A

verci 2.5 to 10 mg once
digoxin 62.5 to 250 mg once
H/ISM 37/20 to 75/40 3 times daily

62
Q

ARNI, MRA,SGLT2

A

has diuretic effect

63
Q

H/ISD

A

after ACEI, ARNI, ARB in pts who canot tolerate and still sympotomatic

64
Q

SR with LBBB more than 150

A

CRT P/D

65
Q

SR with LBBB 130 to 149 or non LBBB more than 150

A

CRT P/D

66
Q

CAD + HF

A

CABG

67
Q

iron defeciency

A

ferric carboxymaltose

68
Q

HR more than 70

A

ivabradine

69
Q

Verciguit

A

victoria trail found that as an add on therapy it decrease risk of CV mortality and HF hospitalization

70
Q

Omecamtiv

A

not liscenced to use

71
Q

ICD as 2ry prevention

A

recommended to reduce the risk of sudden death and all-cause mortality in patients who have recovered from a ventricular arrhythmia causing haemodynamic instability, and who are expected to survive for >1 year with good functional status, in the absence of reversible causes or unless the ventricular arrhythmia has occurred <48 h after a MI

CLASS IA

72
Q

ICD as primary prevention

A

to reduce the risk of sudden death and all-cause mortality in patients with symptomatic HF (NYHA class II-III) of an ischaemic aetiology (unless they have had a MI in the prior 40 days—see below), and an LVEF <_35% despite >_3 months of OMT, provided they are expected to survive substantially longer than 1 year with good functional status

CLASS IA

73
Q

ICD in 1ry prevention

A

to reduce the risk of sudden death and all-cause mortality in patients with symptomatic HF (NYHA class IIIII) of a non-ischaemic aetiology, and an LVEF <_35% despite >_3 months of OMT, provided they are expected to survive substantially longer than 1 year with good functional status

CLASS IIA

74
Q

wearable ICD

A

may be considered for pts at risk of SCD for limited period or as a bridge to implanted device

CLASS IIb

75
Q

ICD 40 days after MI

A

CLASS III not recommended

76
Q

CRT in NYHA class IV

A

not recommended in pts with severe symptoms refractory to OMT unless they are candidates for CRT, VAD, transplant

77
Q

ICD in EF more than 35

A

servival benfit is uncertian

78
Q

Amoidarone

A

has no mortality benfit

79
Q

class I anti arrythmics in HF (disopyramide, flecanide)

A

increase mortlaity

80
Q

DANISH trial

A

showed that ICD in NICM didnt improve the overall mortality risk

so its downgraded to class IIA

81
Q

ICD 40 days after MI

A

increase non arrythmic death

so its contraindicated

82
Q

severe HF pts NYHA class IV where symptoms are refractory to OMT

A

no benefit from ICD

83
Q

CRT

A

recommended for symptomatic patients with HF in SR with a QRS duration >_150 ms and LBBB QRS morphology and with LVEF <_35% despite OMT in order to improve symptoms and reduce morbidity and mortality.

CLASS I

84
Q

CRT rather than RV pacing

A

recommended for patients with HFrEF regardless of NYHA class or QRS width who have an indication for ventricular pacing for high degree AV block in order to reduce morbidity. This includes patients with AF.

CLASS I

85
Q

CRT in QRS greater than 150 and no LBBB

A

CLASS IIA

86
Q

CRT if QRS from 130-149 and LBBB

A

CLASS IIA

87
Q

pts with LVEF less than 35 who recived pacemaker or ICD and developed worsening symptoms

A

upgrade to CRT

88
Q

CRT in QRS 130-149 and non LBBB

A

CLASS IIB

89
Q

if QRS less than 130

A

CRT is class III

90
Q

HFmrEF

A

EF 41-49 with symptoms of HF and elevated NPs

91
Q

treatment of HFmrEF

A

diuretics for HFmrEF and congestion class I

ACEI,ARB, BB, MRA, ENTRESTO CLASS IIB

92
Q

CANDESARTAN in HFmrEF

A

reduce HF hospitalization

93
Q

nebivolol in HFmrEF

A

reduced the composite primary endpoint of all cause mortality and cv hospital admission in SENIORS

94
Q

spironolactone

A

TOPCAT trial in pts with EF from 45-55%
reduced hospitalization

95
Q

digoxin in HFmrEF

A

fewer hospitalization

96
Q

HFpEF measurements

A

LA volume index > 32
In the absence of AF or valve disease, LA enlargement reflects chronically elevated LV filling pressure (in the presence of AF, the threshold is >40 mL/m2)

mitral E velocity > 90
septal e velocity <9 E/e ratio > 9
PASP > 35
TR velocity at rest > 2.8

97
Q

diagnostic approach of HFpEF

A

symptoms and signs of HF + LVEF > or = 50%
+ objective evidence of cardiac structural or functional abnormalities consistent with the presence of lv diastolic dysfunction and raised LV filling pressure including raised NPs

98
Q

pt with EF 40% that improved and present with EF 50%

A

cosidered to have recovered HFrEF or HF with improved EF

99
Q

in AF, meassurement to diagnose HFpEF

A

LA volume index > 40
E/e` ratio >= 15
TR preak velocity > 3.4
LV global longitudinal strain < 16%

100
Q

PCWP in HFpEF
EDP

A

> = 15 at rest or >= 25 exercise
= 16 at rest

101
Q

HFpEF
LV mass index
relative wall thickness

A

> = 95 in female, >= 115 in male
0.42
Although the presence of concentric LV remodelling or hypertrophy is supportive, the absence of LV hypertrophy does not exclude the diagnosis of HFpEF

102
Q

HFpEF
NT proBNP
BNP

A

SR >125
>35

AF >365
>105

103
Q

Treatment of hypertension is recommended to prevent or delay the onset of HF, and to prevent HF hospitalizations.

A

CLASS I

104
Q

Treatment with statins is recommended in patients at high risk of CV disease or with CV disease in order to prevent or delay the onset of HF, and to prevent HF hospitalizations.

A

CLASS I

105
Q

SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin, sotagliflozin) are recommended in patients with diabetes at high risk of CV disease or with CV disease in order to prevent HF hospitalizations

A

CLASS I

106
Q

Influenza and pneumococcal vaccinations should be considered in order to prevent HF hospitalizations

A

CLASS IIA

107
Q

To avoid large volumes of fluid intake. A fluid restriction of 1.52 L/day may be considered in patients with severe HF/hyponatraemia to relieve symptoms and congestion.

A
108
Q

alcohol in HF

A

(2 units per day in men or 1 unit per day in women

109
Q

In the case of increasing dyspnoea or oedema or a sudden unexpected weight gain of >2 kg in 3 days, patients may increase their diuretic dose and/or alert their healthcare team.

A

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