Cardiomyopathy management

Question 1

What are the overlapping pathologies encompassed by congestive heart failure (CHF) and cardiomyopathy (CM)?

Answer 1

Problems with several different aspects of cardiac anatomy and physiology.

Question 2

What are the two commonly used classification systems for heart failure?

Answer 2

New York Heart Association (NYHA) classification and American College of Cardiology/American Heart Association (ACC/AHA) classification.

Question 3

What defines heart failure with preserved ejection fraction (HFpEF)?

Answer 3

Normal ejection fraction (>50%) with evidence of diastolic dysfunction.

Question 4

What is the ejection fraction threshold for heart failure with reduced ejection fraction (HFrEF)?

Answer 4

EF <50%.

Question 5

What are the goals of treating patients with heart failure?

Answer 5

• Improve symptoms
• Reduce morbidity
• Reduce mortality

Question 6

What is a common cause of HFpEF related to ventricular filling?

Answer 6

Concentric hypertrophy due to hypertension.

Question 7

Which class of medications has evidence for improving cardiovascular mortality in HFpEF?

Answer 7

SGLT-2 inhibitors.

Question 8

What is the role of loop diuretics in the management of HFpEF?

Answer 8

Useful for managing symptoms related to fluid overload/hypervolemia.

Question 9

True or False: Beta blockers have convincing evidence of benefit in HFpEF.

Answer 9

False.

Question 10

What are the pharmacologic classes that have definitive benefits for morbidity and mortality in HFrEF?

Answer 10

• RAA antagonists
• Beta blockers
• MRAs
• SGLT-2 inhibitors

Question 11

What is the first-line agent for HFrEF treatment according to current evidence?

Answer 11

Sacubitril-valsartan (neprilysin inhibitor with ARB).

Question 12

What is the indication for mineralocorticoid receptor antagonists in HFrEF?

Answer 12

Improve morbidity and mortality in symptomatic HFrEF.

Question 13

What is the effect of digoxin in heart failure management?

Answer 13

Lowers hospitalization rates but has no effect on mortality.

Question 14

What are common precipitating factors of acute decompensated heart failure (ADHF)?

Answer 14

• Non-compliance with medications
• Excessive salt intake
• New medications
• Other medical conditions

Question 15

What is the primary management focus in patients with ADHF?

Answer 15

Improving hemodynamic parameters.

Question 16

What is the role of vasodilators in managing ADHF?

Answer 16

Useful for heart failure due to increases in afterload.

Question 17

What is the purpose of mechanical support in ADHF?

Answer 17

Provide cardiovascular and/or pulmonary support.

Question 18

What is the indication for an implantable cardioverter-defibrillator (ICD) in heart failure patients?

Answer 18

Patients with EF <35% who are symptomatic on maximal medical therapy.

Question 19

What are the effects of SGLT-2 inhibitors in HFrEF?

Answer 19

Improve morbidity and mortality, even in patients without diabetes.

Question 20

What is the relationship between right ventricular failure and left heart failure?

Answer 20

Right ventricular failure is commonly caused by left heart failure.

Question 21

What does ADHF stand for?

Answer 21

Acute Decompensated Heart Failure

ADHF is a condition where the heart cannot pump enough blood to meet the body’s needs, leading to fluid buildup and symptoms like shortness of breath.

Question 22

What is the role of positive pressure ventilation (PPV) in ADHF?

Answer 22

PPV can improve cardiac output (CO) in ADHF

PPV is used in patients with respiratory distress to assist with breathing and can also support cardiac function.

Question 23

What is an Intraaortic Balloon Pump (IABP)?

Answer 23

An inflatable balloon inserted percutaneously to improve cardiac function

The IABP works by inflating and deflating in sync with the cardiac cycle, enhancing coronary perfusion.

Question 24

What is a Left Ventricular Assist Device (LVAD)?

Answer 24

A battery-powered device implanted to pump blood forward

LVADs are often used as a bridge to heart transplantation.

Question 25

What monitoring is recommended for patients with ADHF?

Answer 25

Telemetry, continuous pulse oximetry, central venous access, arterial line placement, and foley catheter ## Footnote These monitoring methods help in tracking heart rhythm, oxygen levels, volume status, and urine output.

Question 26

What are the two common types of cardiomyopathy?

Answer 26

Hypertrophic cardiomyopathy and dilated cardiomyopathy ## Footnote Hypertrophic cardiomyopathy is characterized by LV hypertrophy, while dilated cardiomyopathy involves enlarged ventricular chambers.

Question 27

What is the prevalence of hypertrophic cardiomyopathy?

Answer 27

1:500 ## Footnote Hypertrophic cardiomyopathy is the most common idiopathic cardiomyopathy.

Question 28

What treatment is often used for symptoms of hypertrophic cardiomyopathy?

Answer 28

Beta blockers ## Footnote Beta blockers help increase filling time and relieve outflow obstruction.

Question 29

True or False: Dilated cardiomyopathy leads to heart failure with reduced ejection fraction (HFrEF).

Answer 29

True ## Footnote Dilated cardiomyopathy is a leading indication for cardiac transplantation and generally results in HFrEF.

Question 30

What genetic mutation is associated with familial dilated cardiomyopathy?

Answer 30

Mutation in the TTN gene ## Footnote The TTN gene codes for the protein titin, which is important for cardiac function.

Question 31

Fill in the blank: _______ is characterized by left ventricular hypertrophy without dilation.

Answer 31

Hypertrophic cardiomyopathy (obstructive cardiomyopathy) ## Footnote This condition can lead to significant health risks, including sudden cardiac death.

Question 32

What is the older name for hypertrophic obstructive cardiomyopathy?

Answer 32

Hypertrophic cardiomyopathy (HOCM) ## Footnote The term reflects the condition's association with left ventricular outflow obstruction.

Question 33

What are some underlying causes that should be treated in patients with cardiomyopathy?

Answer 33

* Autoimmune diseases * Endocrine disorders * Infections * Nutritional deficiencies ## Footnote Addressing these underlying causes is crucial for effective management of cardiomyopathy.

Question 34

What may be necessary for patients with severe symptoms of outflow obstruction in hypertrophic cardiomyopathy?

Answer 34

Debulking procedures such as surgical myomectomy or alcohol septal ablation ## Footnote These procedures may help alleviate symptoms when medication is insufficient.

Question 35

First-line Tx for HFrEF

Answer 35

Sacubitril-valsartan

Question 36

Which type of metroprolol is not indicated in HFrEF?

Answer 36

Shorter-acting version of metoprolol

Question 37

Answer 37

Loop diuretic ## Footnote HCOM Pt's are preload-dependent

Question 38

a) Sacubitril-valsartan b) Diltiazem c) Hydralazine alone d) Isosorbide alone e) Hydralazine and isosorbide dinitrate together

Answer 38

e) Hydralazine and isosorbide dinitrate together

Question 39

Answer 39

Placement of an implantable cardioverter-defibrillator (EF<35%)

Question 40

Indication of hydralazine and isosorbide dinitrate Tx

Answer 40

Intolerance of RAAS medications