Congestive Heart Failure

Question 1

Congestive Heart Failure
Etiology

Answer 1

CAD, HTN, valve abnormalities, cardiomyopathy,
infarction, pericardial disease, myocarditis, cardiac tamponade, metabolic disorders (i.e. hypothyroidism), toxins, congenital

Question 2

Congestive Heart Failure
Precipitants of CHF Exacerbation
Cardiac

Answer 2

Ischemia, dysrhythmias, mechanical complications (i.e.
papillary muscle rupture)

Question 3

Congestive Heart Failure
Precipitants of CHF Exacerbation
Medications

Answer 3

Forgot meds, negative inotropes(CCB, β-blocker), NSAIDs, steroids

Question 4

Congestive Heart Failure
Precipitants of CHF Exacerbation
High Cardiac Output

Answer 4

Anemia, infection, pregnancy,hyperthyroidism

Question 5

Congestive Heart Failure
Precipitants of CHF Exacerbation
Other

Answer 5

Lifestyle (high salt intake), renal failure, PE, HTN

Question 6

Congestive Heart Failure
Assessment
Left-sided Symptoms

Answer 6

SOB, PND, fatigue, orthopnea, angina, syncope,
altered mental status, cough +wheeze (pulmonary congestion)

Question 7

Congestive Heart Failure
Assessment
Right-sided Symptoms

Answer 7

fatigue, abdominal distension, leg swelling, weight
gain, nocturia

Question 8

Congestive Heart Failure
Assessment
Signs
General

Answer 8

tachypnea, tachycardia,hypertension, hypotension, weak pulses

Question 9

Congestive Heart Failure
Assessment
Signs
Left-sided

Answer 9

hypoxia, crackles, wheezes, S3 or S4

Question 10

Congestive Heart Failure
Assessment
Signs
Right-sided

Answer 10

pitting edema, JVP elevation, hepatomegaly, ascites

Question 11

Congestive Heart Failure
Investigations
Labs

Answer 11

CBC, electrolytes, AST, ALT, BUN, Cr, Troponin, BNP (or NT-proBNP)

Question 12

Congestive Heart Failure
Investigations
Tests

Answer 12

CXR, ECG, PoCUS (systolic function, pulmonary edema)

Question 13

Congestive Heart Failure
Management
General

Answer 13

ABCs, monitors, 100% O2 non-rebreather facemask, vitals, IV access, position upright, +/- Foley catheter, treat precipitating factor Morphine 1-2mg IV prn

Question 14

Congestive Heart Failure
Management
First-line

Answer 14

Nitroglycerin 0.4mg sl q5min (if sBP>100) +/- topical nitroglycerin patch (0.2-0.8mg/h)
Furosemide: double home dose, 20mg IV if furosemide naive

Question 15

Congestive Heart Failure
Management
Second-line

Answer 15

Double furosemide dose
Think Sympathetic Crashing Acute Pulmonary Edema (SCAPE):
Nitroglycerin infusion if hypertensive (start 100μg/min & titrate)
Think Cardiogenic Shock if hypotensive (sBP<90): Norepinephrine 2-
12μg/min or Dobutamine 2.5μg/kg/min