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CCFP 3 > CHF > Flashcards

CHF Flashcards

1
Q

NYHA classes

A

1 = asymptomatic, no limit on physical activity
2 = symptoms w/ ordinary activity, slight limits
3 = symptoms w/ < ordinary activity, moderate limits
4 = symptoms at rest, severe limits

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2
Q

Types of HF

A

HFpEF = LVEF >50%
HFmEF = LVEF 41-49%
HFrEF = LVEF <40%

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3
Q

Causes of HF

A

Cardiac: tachycardia, valve disease, CAD, LVH
Toxins: alcohol, amphetamines, cocaine, steroids, radiation
Pregnancy: cardiomyopathy, pre-e, GDM
Inflammation/ infections: myocarditis, sarcoidosis
Metabolic: DM, thyroid, pheochromocytoma, Cushings
Nutritional: low thiamine, malnutrition, obesity, anemia

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4
Q

RF

A

Older age
Fam hx
Smoking
Alcohol
Chemotherapy
Obesity
HTN
High lipids
IHD/ CAD
DM

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5
Q

Precipitating factors

A

Forgetting meds
Arrhythmia
Anemia
Ischemia
Infection
Pregnancy
Hyperthyroidism
Renal failure
PE

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6
Q

Prevention

A

Exercise
Treat dyslipidemia, HTN, DM
Smoking cessation

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7
Q

Screening

A

BNP for at risk pts - identifies those that need an echo

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8
Q

Sx

A

Fatigue, wt gain, weakness
Orthopnea, PND
Cough, SOBOE
Nocturia, edema, abdo distension

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9
Q

Signs

A

Hypotension
Tachycardia
Hypoxia
Weight gain
Raised JVP
Displaced apex
S3 murmur
+AJR
Edema

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10
Q

Ix + results

A

CBC, lytes, lipids, TSH, urinalysis, trop, BNP
CXR
Interstitial Edema
Kerley B Lines
Pleural Effusions
Cardiomegaly
Echo
Reduced LVEF
Increased LV end-systolic + diastolic dysfunction
LVH
Wall motion abnormalities
Valve dysfunction
ECG
Exercise stress test to assess functional capacity

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11
Q

Management HFrEF

A

BB (bisoprolol)
Spironolactone (mineralcorticoid receptor antagonist)
ACEi (ramipril)
SGLT2i (empagliflozin)

If not working, switch ACEi for ARNI (scubitril)

If still symptomatic, consider
Ivabradine
ICD/ CRT
Heart transplant

Nitrates for SOB/ angina PRN
Loop diuretic for sx control

Omega 3 polyunsaturated fatty acids 1g daily

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12
Q

Management HFpEF

A

ACEi/ ARB + BB
Consider spironolactone

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13
Q

Monitoring

A

Weight, HR, orthostatic vitals, JVP, edema
Check lytes 1 week after adjusting diuretic, ACEi or ARB
Digoxin trough 12hrs post dose
Repeat echo 3 months after titrating meds + q1-3 yrs if stable
Check BNP after titrating triple therapy

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14
Q

Patient education + self monitoring

A

Self-weighing
Monitoring sx: worsening cough, SOB at rest, edema, wt gain, diiziness
Healthy diet - restrict salt + fluids (<1.5L/d)
Flu shot + pneumococcal vaccine annually
Sleep in upright position
Medication adherence
Smoking cessation
Exercise that does not induce sx
Supervised cardiac rehab for NYHA 1-2
Supervised mod aerobic + resistance training for NYHA 2-3
Assess for cognitive impairment, dementia and depression

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15
Q

Acute HF management

A

ECG, CXR, lytes, Cr, CBC, trop, BNP
Admit if NYHA 3-4, hypoxia, new dx, worsening renal function
BIPAP: 14/8 or 10/5
IV Lasix 20-80mg
If hypotensive, give inotropes like dobutamine milrinone

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16
Q

When to refer

A

Initial HF dx
After hospitalisation
HF w/ ischemia, HTN, valve disease, syncope, renal dysfunction

17
Q

CHF acute management

A

oxygen, BiPAP, lasix, nitro if hypertensive

18
Q

CHF + hypotension = what? What do you do about it?

A

cardiogenic shock, urgent cardio referral, arrange transfer, norepi

19
Q

Steps prior to case turning up in ED

A

don PPE, call for help, call lab + XR in, assign roles

20
Q

Most common cause of CHF

A

ischemic cardiomyopathy

21
Q

When to refer pts for heart transplant or ICD?

A

NYHA class 3, 4, advanced HF, high risk

22
Q

When to refer pts for CRT or ICD?

A

LVEF <35%

23
Q

HFpEF rx

A

SGLT2i

24
Q

HFrEF rx

A

BB, ACEi, spironolactone, SGLT2i

25
Q

HFrEF triple therapy x3mo, no improvement, what to offer?

A

Entresto (Sacubitril / Valsartan i.e. angiotensin receptor-neprilysin inhibitor), vericiguat, digoxin, ICD/ CRT, transplant

26
Q

What to add in CHF w/ HR >75?

A

Ivabradine (HCN channel blocker)

27
Q

Indicators of advanced CHF

A

recurrent hospitalisations, cardiac cachexia, intolerance of BB, inability to walk 1 block on level ground, maximal diuretic therapy, frequent ICD shocks, progressive decline in renal function

28
Q

Physical exam in CHF

A

weight, volume status, peripheral vascular exam, leg edema, lung sounds, JVP, S3

29
Q

What score do you use to dx HFpEF + what are the components?

A

H2FPEF = heavy (BMI >35), hypertensive, aFib, pulmonary HTN, Elder >80, filling pressure

30
Q

What can you consider switching black pts or pts that are intolerant of ACEi/ ARBs to?

A

consider H-ISDN (hydralazine/ isosorbide dinitrate)

31
Q

What could you add for pts that have had a recent hospitalisation?

A

Vericiguat

CCFP 3 (67 decks)

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