OnlineMedEd: Intern Content - "CHF I Clinic"

Question 1

The two most important organs that the left heart pumps to are __________________.

Answer 1

the brain and the kidney

Look for symptoms of syncope, presyncope, and renal failure.

Question 2

True or false: the SVR is decreased in CHF.

Answer 2

False

In CHF, the kidneys are not adequately perfused. This results in an increased release of renin which activates more angiotensin II. This increases the sodium resorption AND the SVR.

Question 3

The triad of CHF symptoms are ____________.

Answer 3

dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea

Question 4

The signs of CHF are _________________.

Answer 4

right-sided:

• JVD
• Peripheral edema
• Ascites
• Hepatojugular reflex

left-sided:
- bibasilar inspiratory crackles

both:
- S3
- laterally and inferiorly displaced PMI

Question 5

What tests should you order in evaluating heart failure?

Answer 5

• BNP: < 100 excludes it; > 500 confirms it (both pending clinical confirmation)
• ECG: past infarctions and current arrhythmias
• ECHO: evaluating size and volume (i.e., HFrEF vs. HFpEF)
• Left heart catheterization: look for coronary occlusion (which would confirm ischemic cardiomyopathy)
• Right heart catheterization: look for elevated pulmonary pressure

Question 6

________________ can make people in CHF have normal BNPs.

Answer 6

Obesity

Question 7

Review the classification of HF.

Answer 7

New York Heart Association classes:
•I (no symptoms, unlimited exercise potential):
- ACEi and BB (metoprolol and carvedilol most studied)

•II (symptoms with moderate exertion, like walking up a couple flights of stairs):
- ACEi, BB, diuretic

•III (symptoms with minor exertion, like walking around the house):
- ACEi, BB, diuretic, spironolactone or isosorbide dinitrate/hydralazine

•IV (symptoms at rest)
- ACEi, BB, diuretic, spironolactone or isosorbide dinitrate/hydralazine, transplant, inotropes

Question 8

Why is spironolactone preferred over IDN-hydralazine?

Answer 8

Spironolactone is QD, IDN-H is TID.

Question 9

All patients with CHF should have what lifestyle interventions?

Answer 9

• < 2 g NaCl

* < 2 L H2O

Question 10

Which patients are candidates for automated implanted cardiac defibrillators (AICDs)?

Answer 10

• Class I - III

* EF < 35%

Question 11

List the important things to note in a clinical note for CHF.

Answer 11

• Functional status
• Weight gain
• PE: edema, crackles, JVD
• Medications
• EF, HFrEF or HFpEF,
• Change in symptoms