Management of HF Part 1

Question 1

Causes of CHF

Answer 1

CAD/MI
Hypertension
Diabetes
Valvular heart disease
Cardiomyopathy/myocarditis
Congenital heart disease
Diastolic heart failure
Other (sarcoidosis, HIV, etc)

Question 2

Signs of acute HF

Answer 2

Respiratory distress (hypoxemia, orthopnea, tachypnea, tachycardia)
May be hyper or hypotensive (hypo suggests cardiogenic shock)
Use of accessory muscles

Question 3

4 pharmacological interventions for acute CHF

Answer 3

Diuretics
Vasodilators
Morphine
Inotropes

Question 4

Diuretics for CHF

Answer 4

Lasix (loop diruetic) is first line treatment
Peak diuresis 30 mins later
Provides symptomatic relief (reduces intravascular volume, venodilation)

Question 5

Vasodilators for CHF

Answer 5

Nitroglycerine, nitroprusside
Patients with normal to high BP
In addition to diuretic therapy
Rapidly reduces LV filling pressure via venodilation
Also decreases systemic vascular resistance, ventricular workload, and improves cardiac output

Question 6

Inotropes for CHF

Answer 6

Inotropes increase contractility

Helps maintain systemic perfusion and preserve end organ function

Question 7

Morphine for CHF

Answer 7

Reduces patient anxiety and decreases work of breathing

But is associated with increases frequency of mechanical ventilation and in-hospital mortality

Question 8

3 Mechanical interventions for CHF

Answer 8

Intra-aortic balloon pump
Impella
Left ventricular assist device

Question 9

Diastolic HF (HFpEF)

Answer 9

CHF symptoms despite normal LV systolic function
Lower mortality than patients with systolic CHF
Primarily a relaxation problem (decreased diastolic filling, increased LVEDP and pulmonary congestion)
Causes: aging heart, HTN, hypertrophic cardiomyopathy, ischemia)

Question 10

Triple therapy for CHF

Answer 10

ACE or ARB
Beta blocker
Mineralocorticoid receptor antagonist

Question 11

AT1 receptor effects of AII

Answer 11

Vasoconstriction
Sympathetic tone
Sodium reabsorption
Aldosterone
Smooth muscle proliferation

Question 12

4 contraindications to B blockers

Answer 12

Symptomatic hypotension
Bradycardia
Significant AV block
Severe asthma

Question 13

Entresto

Answer 13

Angiotensin receptor and neprilysin inhibitor
Morbidity and mortality benefit with HF
Inhibits NEP (thereby promoting beneficial effects of natriuretic peptides) and blocks the AT1 receptor

Question 14

Ivabradine (Lancora)

Answer 14

Blocks the sinus node (decreased HR with no effect on BP or contractility)
Elevated HR is associated with poor outcomes