Cardiovascular Conditions: Chronic Heart Failure

Question 1

HFrEF has a EF of…..

Answer 1

< 40%

Question 2

HFmrEF has EF of….

Answer 2

41%-49%

Question 3

HFpEF has EF of…

Answer 3

> 50%H

Question 4

HFimpEF is when EF….

Answer 4

goes from < 40% to > 40%, its improved

Question 5

NYHA stage 1

Answer 5

no limitations on physical activity
ordinary physical activity doesnt cause symptoms of HF

Question 6

NYHA stage 2

Answer 6

slight limitations on physical activity
comfortable at rest, but ordinary physical activity results in symptoms of HF

Question 7

NYHA stage 3

Answer 7

Limitation of physical activity
Comfortable at rest, but minimal exertion causes symptoms of HF

Question 8

NYHA stage 4

Answer 8

unable to carry on any physical activity without symptoms of HF or symptoms of HF at rest

Question 9

NYHA stage 5

Answer 9

unable to carry on any physical activity without symptoms of HF or symptoms of HF at rest

Question 10

Cardiac output =

Answer 10

Heart rate X Stroke Volume

Question 11

Lifestyle management for HF patients

Answer 11

monitor weight daily
notify provider if weight up 2/4lbs in day or 3/5lbs in week

Question 12

Guideline HFrEF treatments

Answer 12

ACE/ARB/ARNi
BB
Aldosterone receptor antagonist
SGLT2i
Loop diuretics

Add on: Hydralazine+ nitrate/Ivabradine/Digoxin

Question 13

Entresto (Sacubitril/Valsartan) info

Answer 13

start 24/26 BID, target dose of 97/103 BID

Question 14

Entresto boxed warning

Answer 14

Dont use if pregnant, can cause injury and death to developing fetus

Question 15

Entreso CI

Answer 15

dont use within 36hrs of ACE
Dont use if hx of angioedema

Question 16

Entresto notes

Answer 16

dont need washout when switching from an ARB

Question 17

Which Beta-Blockers recommended in HF?

Answer 17

Bisoprolol
Carvedilol
Metoprolol succinate ER

Question 18

Spironolactone vs Eplerenone MOA

Answer 18

Spiro = non selective, also blocks androgen and exhibits endocrine side effects
Epler = selective, doesnt exhibit endocrine side effects

Question 19

Spironolactone/Eplerenone CI

Answer 19

Hyperkalemia
Severe renal impairment
Addisons disease

Question 20

Spironolactone/Eplerenone warnings

Answer 20

Dont start for HF if K > 5, 5.5 for eplere
CrCl < 40
ScR < 2 = females, < 1.5 = males

Question 21

Spironolactone side effects

Answer 21

Gynecomastia
Breast tenderness
impotence

Question 22

SGLT2i for HF

Answer 22

Dapagliflozin = dont start if eGFR < 25ml
Empagliflozin = dont start if eGFR < 20ml

Question 23

Loop diuretic conversions

Answer 23

Furosemide = 40mg : Yosemite = 20mg = Bumetanide = 1mg

Question 24

Furosemide PO:IV

Answer 24

40mg PO = 20mg IV

Question 25

Loop diuretic drug interactions

Answer 25

avoid NSAIDs

Question 26

BiDil is for…

Answer 26

self identified black patients with NYHA class III/IV HF who are symptomatic despite optimal treatment with an ARNI/ACE/ARB/BB/ARA/SGLT2

used as add on

Question 27

BiDil =

Answer 27

Hydralazine/Isosorbide Dinitrate

Question 28

BiDil contraindications

Answer 28

Dont use with PDE-5i or riociguat

Question 29

Ivabradine uses

Answer 29

doesn’t reduce mortality, but does reduce risk of hospitalizations

should be used if resting HR < 70 BPM, pts with Class 2/3 NYHA and HF < 35%

Question 30

Digoxin MOA

Answer 30

inhibits NA-K-ATPase pump, causing inc CO and dec HR

Question 31

Digoxin dosing

Answer 31

goal of < 1ng/mL in HF

Question 32

Digoxin toxicity

Answer 32

N/V
Loss of appetite
Blurred/double vision
greenish-yellow halos
bradycardia
life threatening arrhythmias

Question 33

Digoxin antidote

Answer 33

DigiFab

Question 34

Digoxin dosing adjustments

Answer 34

CrCl < 50mL = dec dose
Dec dose 20%/25% when switching PO to IV

Question 35

Digoxin drug interactions

Answer 35

reduce dose by 50% when starting amiodarone

Question 36

Vericiguat Info

Answer 36

Boxed warning: dont use if pregnant
CI: dont use with riociguat

SE: Hypotension, anemia, dyspepsia

Question 37

Potassium supplementation

Answer 37

Should be checked with drug dose changes

Check mag first before potassium, low mag can effect potassium

Question 38

Which Klor-Con can be dissolved in water?

Answer 38

Klor-Con M