HF HYHO

Question 1

PND

Answer 1

Major

Question 2

Orthopnea

Answer 2

Major

Question 3

Elevated JVP

Answer 3

Major

Question 4

Crepitations

Answer 4

Major

Question 5

S3

Answer 5

Major

Question 6

CXR evidence of CM

Answer 6

Major

Question 7

CXR evidence of pulmonary edema

Answer 7

Major

Question 8

Extremity edema

Answer 8

Minor

Question 9

Night cough

Answer 9

Minor

Question 10

Exertion dyspnea

Answer 10

Minor

Question 11

Hepatomegaly

Answer 11

Minor

Question 12

Pleural effusion

Answer 12

Minor

Question 13

HR > 120

Answer 13

Minor

Question 14

Loss of > 4.5 kg in 5 days post-diuretics

Answer 14

Minor

Question 15

HFrEF characteristics

Answer 15

EF < 40%
Systolic (pressure overload)
(dilated CM)

Question 16

MCC of HFrEF?

Answer 16

CAD

Question 17

HFrEF does what to heart?

Answer 17

LV dilation

Question 18

HFpEF characteristics

Answer 18

EF > 50%

Diastolic (volume overload)

Question 19

MCC of HFpEF?

Answer 19

Systemic HTN

Question 20

HFpEF does what to heart?

Answer 20

LVH
elevated LA pressure
decreased LV compliance
impaired LV relaxation

Question 21

Main tx for HFpEF?

Answer 21

Manage the comorbid conditions (HTN, AFib, IHD, DM)

Question 22

Main tx for HFrEF? (first line)

Answer 22

ACEIs (ARBs) and BBs (MRA if sx continue)

Question 23

What else can be used to tx HFrEF (also first-line)

Answer 23

Hydralazine and nitrate

Question 24

What are 2nd line txs for HFrEF?

Answer 24

1. Replace ACEI w/ sacubitril or valsartan
2. Add ivabradine (if in sinus rhythm, and HR is >75 and LVEF is < 35%)
3. Hydralazine and nitrate
4. Digoxin

Question 25

Who can especially benefit from hydralazine and nitrate therapy?

Answer 25

African Americans and Caribbeans

Question 26

Treatment plan for ADHF?

Answer 26

1. Monitor O2, VS, cardiac rhythm
2. Provide supplemental O2, place 2 IVs, position upright
3. Intubation if necessary
4. Diuretic therapy (LOOPs)
5. Search for cause

Question 27

What needs to be done to diuretic dosage in renal dysfunction pts?

Answer 27

Higher dosages

Question 28

Tx for pts w/ adequate end-organ perfusion (normal/elevated BP)

Answer 28

• Early vasodilator therapy (if afterload needs to drop)
• Nitroprusside for severe HTN
• If diuretic response is inadequate, give vasodilator to reduce preload (IV nitroglycerin)

Question 29

Tx for pts w/ known systolic HF/signs of ADHF/cardiogenic shock?

Answer 29

• STOP BB

- Give IV inotrope (aka dobutamine)

Question 30

Tx for pts w/ known diastolic HF/signs of ADHF/cardiogenic shock?

Answer 30

• Tx for LV outflow obstruction w/ BB, IV fluids and IV vasopressor (phenylephrine/NE)
• Do NOT give inotrope/vasodilator
• Consider AR or MR possibility or aortic dissection

Question 31

Tx for pts w/ unknown cardiac status?

Answer 31

• IV inotrope w/ or w/o vasopressor

- Assess need for mechanical support

Question 32

Initial eval for HF pt

Answer 32

1. Hx
2. PE
3. Labs/BNP level
4. CXR
5. Echo
6. Framingham criteria (2 major/1 major+1 minor)

Question 33

DDx for acute onset/rapid progression

Answer 33

• PE
• Pneumothorax
• LV failure
• Asthma
• Inhaled foreign body

Question 34

DDx for gradual onset and progression over hrs-days

Answer 34

• Pneumonia
• Asthma
• COPD exacberation

Question 35

DDx for gradual onset and progression over weeks-months

Answer 35

• Anemia
• Pleural effusion
• NM respiratory disorder

Question 36

DDx for gradual onset over months-years

Answer 36

• COPD
• Pulmonary fibrosis
• TB