B4.028 - Heart Failure Treatments

Question 1

what is the growth of HF population due to

Answer 1

improved management of cardiac disease

Question 2

systolic cardiac dysfunction

Answer 2

impaired ability to eject blood

Question 3

diastolic cardiac dysfunction

Answer 3

impaired ability of LV to fill with blood

Question 4

clinically what is heart failure

Answer 4

inability to adequately supply blood to metabolizing body tissues

Question 5

What is HFpEF

Answer 5

heart failure with preserved ejection fraction diastolic HF

Question 6

which type of HF has had therapies shown to be effective

Answer 6

HFrEF

Question 7

what is HFrEF

Answer 7

Heart failure with reduced ejection fraction Systolic HF

Question 8

underlying causes of HF

Answer 8

1. coronary artery disease 2. Hypertension 3. myocardial disease 4. valvular disease 5. pericardial disease

Question 9

what are the types of Myocardial disease that can lead to HF

Answer 9

dilated infiltrative inflammatory hypertrophic stress cardiomyopathy

Question 10

what are valvular diseases that can cause HF

Answer 10

aortic stenosis aortic regurgitation mitral stenosis mitral regurgitation

Question 11

pericardial disease that can cause HF

Answer 11

tamponade constrictive pericarditis

Question 12

describe the fundamental causes of HF

Answer 12

increased hemodynamic burden or impaired myocardial oxygen delivery triggers biochemical and physiological mechanisms that impact contractility and may promote vasoconstirtion and increased resistance, as well as sodium and fluid retnention

Question 13

what are some systems that can be fundamental causes of HF

Answer 13

renin angiotensin system activation

sympathetic nervous system activation

remodeling due to myocardial changes

Question 14

what are precipitating causes of HF

Answer 14

inappropriate reduction of therapy arrhythmias MI infection PE unrelated illness Drugs cardiac toxins severe stress

Question 15

what is HF (type of condition)

Answer 15

syndrome

Question 16

patients with asymptomatic LV dysfunction are 5x more likely to develop what

Answer 16

HF clinical syndrome

Question 17

presentation of HF

Answer 17

decreased exercise tolerance manifestations of fluid retention discomfort at rest increased TPR

Question 18

heart failure risk factors

Answer 18

HT coronary artery disease DM obesity smoking valvular heart disease

Question 19

diastolic dysfunction risk factors

Answer 19

female older HT

Question 20

is systolic or diastolic HF more common

Answer 20

systolic

Question 21

what happens to PMI in HF

Answer 21

may be shifted left

Question 22

describe characteristic age of people with diastolic and systolic HF

Answer 22

diastolic - elderly systolic - any ages, 50-70

Question 23

typical sex of diastolic and systolic HF

Answer 23

diastolic - female systolic - male

Question 24

left ventricular cavity size in diastolic and systolic HF

Answer 24

diastolic - usually normal, LVH systolic - usually dilated

Question 25

which heart sound is associated with systolic and diastolic HF

Answer 25

diastolic - S4 systolic - S3

Question 26

what are tests to run for HF Dx

Answer 26

ECG CXR Echo CMR Blood chemistry (BNP)

Question 27

what can an echo tell you

Answer 27

EF Chamber sizes Wall thickness Regional wall motion abnormalities valve abnormalities doppler assessment of diastolic function

Question 28

what is BNP

Answer 28

seen in acute heart failure increased hormone level with increased ventricular wall stress due to pressure/volume overload

Question 29

what levels of BNP are needed for a diagnosis fo HF

Answer 29

\<100 - acute HF unlikely \>500 - acute HF likely

Question 30

what are the classes of heart failure

Answer 30

class 1 - asymptomatic class 2 - symptoms with heavy exertion class 3 - symptoms with mild exertion class 4 - symptoms at rest

Question 31

what are the determinants of stroke volume

Answer 31

preload contractility afterload heart rate cardiac output LV contraction, wall integrity, valve competence HR

Question 32

what are the medical treatment options for Systolic HF

Answer 32

Vasodilators Beta blockers ACE Inhibitors Entresto Corlanor

Question 33

what do vasodilators do in CHF

Answer 33

reduce preload and afterload

Question 34

what do beta blockers do in SHF

Answer 34

reduce HR and sympathetic overactivity

Question 35

what are the beta blockers for HF

Answer 35

carvedilol, bisoprolol, metoprolol succinate

Question 36

what medications for SHF dont improve outcome but have a role in symptom management

Answer 36

digoxin - inotropic agents diuretics

Question 37

what is stage A SHF and what do you treat with

Answer 37

High risk no symptoms preventative, lifestyle changes, risk factor reduction

Question 38

what is stage B SHF and how do you treat

Answer 38

structural heart disease, no symptoms ACE inhibitors or ARBs in all patients; beta blockers in selected patients

Question 39

what is stage C SHF and how do you treat

Answer 39

structural disease, previous or current symptoms ACE inhibitors and beta blockers in all

Question 40

what is stage D SHF and how do you treat

Answer 40

refractory symptoms inotropes

Question 41

describe stage A HF and what goals of treatment/treaments are

Answer 41

Question 42

what is stage B HF and what are the goals of treatment/treatments

Answer 42

Question 43

what is stage C HF and what are goals of treatment/treatments for it

Answer 43

Question 44

what is stage D HF and what are goals of treatment/treatments for it

Answer 44

Question 45

Describe stage A HF medical interventions

Answer 45

Question 46

Stage B HF recommendations Structural heart disease but without signs or symptoms of HF

Answer 46

Question 47

Stage C nonpharma interventions

Answer 47

Also: continuous positive airway pressure (CPAP) for sleep apnea Cardiac rehab

Question 48

pharm therapy for stage C HFrEF

Answer 48

Beta blockers Aldosterone antagonists hydralazine and isosorbide dinitrate (vasodilators)

Question 49

should you give calcium channel blockers to stage C HF paitents?

Answer 49

God NO

Question 50

Describe the magnitute of benefit for Stage C HFrEF for ACE I, Beta blockers, aldosterone antagonists, hydralazine/nitrate

Answer 50

Question 51

what are treatment options for HFpEF

Answer 51

Question 52

what are device treatments for stage C HFrEF

Answer 52

ICD - uses electrical pulses or shocks to help control life-threatening arrhythmias, especially those than can cause sudden cardiac arrest/death CRT - sequentally paces cardiac ventricles in a more synchronized and physiologic pattern

Question 53

what are treatments for stage D HF

Answer 53

water restriction inotropic support mechanical circulatory support LVAD cardiac transplantation

Question 54

what are the most recommended therapies for hospitalized HF patients

Answer 54

Question 55

what are surgical/percutaneous/transcatheter interventional treatments of HF

Answer 55

CABG PCI aortic or mitral valve surgery resection of ventricular aneurysm