Congestive Heart Failure

Question 1

CHF

causes

10

Answer 1

1. MI
2. arrhythmias
3. uncontrolled HTN
4. dietary/med noncompliance
5. substance abuse
6. anemia
7. hyper thyroidism
8. AKI
9. PE
10. sepsis

Question 2

CHF

what is it?

Answer 2

sx of hypervolemia due to impaired cardiac function (decreased filling/decreased squeezing)

Question 3

CHF

normal EF

Answer 3

55-65%

Question 4

CHF

what do you need to differentiate? how do you do it?

Answer 4

1. HFpEF vs HFrEF
2. echo

Question 5

CHF

describe Stage A

Answer 5

pateitns at risk for CHF but without sx, structural changes, or elevated biomarkers

Question 6

CHF

describe Stage B

Answer 6

patients without current sympoms of CHF, but has one of the following:
* structural heart disease
* abnormal cardiac function
* elevated cardiac biomarkers

Question 7

CHF

describe stage C

Answer 7

patients with current or prior symptoms and/or structural changes and/or elevated cardiac biomarkers

Question 8

CHF

describe Stage D

Answer 8

severe sx at rest, recurrent hospitalizations despite GDMT, intolerant to GDMT, requires advanced therapies (transplant, mechanical circulation), palliative care

Question 9

CHF

a pt present with new dx of CHF. Echo shows EF is 55%. What is the best documentation?

Answer 9

acute HFpEF

Question 10

CHF

presentation of right sided

3

Answer 10

1. pedal edema
2. abdominal bloating
3. nausea/decreased appetite

Question 11

CHF

presentation of left sided

4

Answer 11

1. DOE/SOB
2. orthopnea
3. cough
4. decreased exercise tolerance

Question 12

CHF

Physical Exam Findings of Right Sided

6

Answer 12

1. distended neck veins (JVP > 8cm)
2. abd distension
3. pedal edema (1-4+)
4. hepatojugular reflux
5. ascites
6. liver enlargement/tenderness

Question 13

CHF

PE findings of left sided

3

Answer 13

1. rales/crackles/wheezes
2. dullness to percussion
3. S3, S4, or gallop

Question 14

signs/sx of low perfusion

6

Answer 14

1. narrow pulse pressure
2. sleepy
3. low sodium
4. cool extremities
5. hypotension on ACE
6. renal/hepatic dysfunction

Question 15

signs/sx of congestion

6

Answer 15

1. orthopnea/PND
2. JVP distension
3. hepatomegaly
4. edema
5. rales
6. abd jugular reflux

Question 16

CHF

Lab work up

4

Answer 16

1. BMP or CMP
2. BNP or pro-BNP
3. TSH
4. CBC

Question 17

CHF

diagnostic work up

3

Answer 17

1. echo
2. EKG
3. CXR

Question 18

CHF

what can falsely lower BNP?

Answer 18

obesity or CKD

Question 19

CHF

what can falsely elevate BNP?

Answer 19

ARNI (entresto)

Question 20

CHF

EKG findings?

4

Answer 20

1. LVH
2. afib or atrial flutter
3. LBBB
4. Q waves (old MI?)

Question 21

CHF

CXR findings

ABBCDEE

Answer 21

1. Alveolar edema
2. Blunting of margins
3. Kerley B lines
4. Cardiomegaly
5. Dilated upper lobe vessels
6. Pleural effusion
7. PE

Question 22

CHF

how to navigate CHF?

4 components

Answer 22

1. Dx (echo, BNP, then stage)
2. work up (reversible?, est baseline tests)
3. Treat sx
4. follow up

Question 23

CHF

4 components of tx

Answer 23

1. symptom relief
2. tx of underlying disorders
3. education
4. Rx: fantastic 4

Question 24

CHF

what are the fantastic 4 meds?

Answer 24

1. BB
2. ARNI/ACE/ARB
3. Spironolactone
4. SGLT-2 Inhibitor

Question 25

# CHF which meds provide sx relief?

Answer 25

loop diuretics

Question 26

# CHF what education can be provided?

Answer 26

1. low sodium diet 2. 2L fluid restriction 3. exercise 4. optimal BMI 5. med compliance 6. watch for warning sx

Question 27

# CHF tx of HFpEF with LVEF < 50%

Answer 27

1. Diuretics PRN 2. SGLT2 3. ARNI 4. MRA 5. ARB

Question 28

# CHF heart failure tx goals

Answer 28

1. BP < 120/80 2. HR: < 70 bpm 3. Euvolemic (warm + dry)

Question 28

# CHF tx of HfmrEF

Answer 28

1. Diuretics PRN 2. SGLT2 3. ACE/ARB/ARNI 4. MRA 5. BB

Question 29

# CHF which loop diuretics? | 3

Answer 29

1. furosemide 2. torsemide 3. bumetanide

Question 30

# CHF which SGLT-2 Inhibitors? | 3

Answer 30

1. dapagilflozin 2. empagliflozin 3. canagliflozin

Question 31

# CHF which ARNI?

Answer 31

1. entresto

Question 32

# CHF which MRAs? | 2

Answer 32

1. Spironolactone 2. Eplerenone ($$)

Question 33

# CHF which BB should be avoided in CHF?

Answer 33

atenolol

Question 34

# CHF which BB are most rec for CHF?

Answer 34

1. carvedilol 2. metoprolol

Question 35

# CHF drugs to avoid if EF < 40%

Answer 35

1. NSAIDs or COX-2 inhibitors 2. CCBs: diltiazem, verapamil 3. ACE/ARNI/ARB combos 4. thiazolidinediones (pioglitazone, rosiglitazone) 5. sulfonylureas

Question 36

# CHF what does " I NEED HELP" stand for for CHF tx

Answer 36

* I: intravenous inotropes * N: NYHA calss IIIB to IV or persistently elevated natriuretic peptides * E: end organ dysfunction * E: EF < 35% * D: defibrillation * H: hospitalizations > 1 * E: edema despite escalating diuretics * L: low systolic BP (< 90), high HR * P: prognostic medication; progressive tolerance or down-tiltration of GDMT