Pathophysiology of CHF

Question 1

Normal EF range

Answer 1

60-80%

Question 2

SHF has an EF of less than

Answer 2

40%

Question 3

NYHA classification

Answer 3

1. No limitations
2. Limitations (fatigue & SOB) with moderate activity (going up one flight of stairs)
3. Limitation with minimal activity (walk across the room)
4. SOB even at rest

Question 4

Treatment principles of systolic dysfunction?

Answer 4

4Dis:

• Diuretics: loop & K-sparing
• Diet: <2L/d
• Digoxin: + inotrope
• Dilators: ACEI and low dose BB

Question 5

Limitation in Salt and fluid intake in a day in SHF?

Answer 5

• Salt: < 2 g/day

- Fluid: < 2L/day

Question 6

3 Drugs classes shown to help with morbidity/mortality in CHF

Answer 6

• ACEI/ARB
• Low dose BB
• Aldosterone antagonist

Question 7

Drugs have NOT been shown to help with morbidity and mortality in SHF

Answer 7

• Loop Diuretics
• Digoxin
  These are to help with symptoms

Question 8

Treatment principles of diastolic HF

Answer 8

• Low dose BB
• NDHP-CCB: Verapamil and diltiazem
• DHPs have no/minimal effect on heart

Question 9

CHF tests/monitoring

Answer 9

• Echocardiogram: EF%
• BNP: B-Type => during flare up >500
• PCWP (Pulmonary Capillary Wedge Pressure): > 21 mm Hg
• CXR: Cardiomegaly
• Weight Gain: fluid retention

Question 10

CHF BP Goal

DM or CKD BP goal

Answer 10

• CHF: < 130/80 mm Hg; also consider < 120/80 mm Hg if can

- DM or CKD: < 130/80 mm Hg