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Master the boards: Cardiology > Congestive Heart Failure (CHF) > Flashcards

Congestive Heart Failure (CHF) Flashcards

(50 cards)

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1
Q

What is Systolic Dysfunction?

A

Decreased ejection fraction and dilation of the heart

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2
Q

What is diastolic dysfunction?

A

Inability of the heart to relax and receive blood with a normal ejection fraction

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3
Q

What is the most common cause of CHF?

A

Hypertension resulting in a cardiomyopathy or abnormality of the myocardial muscle

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4
Q

What is the most likely diagnosis for Dyspnea with sudden onset and clear lungs?

A

Pulmonary Embolus

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5
Q

What is the most likely cause for Dyspnea with sudden onset, wheezing and an increased expiratory phase?

A

Asthma

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6
Q

What is the most likely diagnosis for dyspnea with slower, fever, sputum and unilateral rales/rhonchi?

A

Pneumonia

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7
Q

What is the most likely diagnosis for Dyspnea with Decreased unilateral breath sounds and tracheal deviation?

A

Pneumothorax

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8
Q

What is the most likely diagnosis for dyspnea with circumoral numbness, caffeine use and a history of anxiety?

A

Panic attack

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9
Q

What is the most likely diagnosis for dyspnea with pallor, and gradual onset over days to weeks?

A

Anemia

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10
Q

What is the most likely diagnosis for dyspnea with pulsus paradoxus, decreased heart sounds and JVD?

A

Tamponade

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11
Q

What is the most likely diagnosis for Dyspnea with Palpitations and syncope?

A

Arrhythmia

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12
Q

What is the most likely diagnosis for Dyspnea with dullness to percussion at the bases?

A

Pleural Effusion

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13
Q

What is the most likely diagnosis for Dyspnea with Long smoking hx and barrell chest?

A

COPD

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14
Q

What is the most likely diagnosis for dyspnea with recent anesthetic use, brown blood not improved with oxygen, clear lungs and cyanosis?

A

Methemeglobinemia

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15
Q

What is the most likely diagnosis for Dyspnea with burning building or car, wood-burning stove etc?

A

Carbon Monoxide Poisoning

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16
Q

What is the most important Diagnostic Test in CHF?

A

Echocardiogram

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17
Q

What is the best initial test to evaluate ejection fraction in CHF?

A

Transthoracic Echocardiogram (TTE)

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18
Q

What is the most accurate test to assess ejection fraction abnormalities?

A

Multiple-gated acquisition scan (MUGA)

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19
Q

What drug classes are used in the treatment of Systolic Dysfunction?

A

ACEI or ARB
Sacubitril/Vasartan
Beta Blockers
Mineralocorticoid Receptor Antagonists
SGLT2 Inhibitors
Digoxin
Diuretics

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20
Q

What patients with systolic dysfunction should receive ACEI/ARB?

A

All patients at any stage of disease

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21
Q

What are common adverse effects of ACEI/ARB?

Study These Flashcards
A

Hyperkalemia, cough, angioedema

22
Q

How do you manage Hyperkalemia from ACEI or ARB use?

Study These Flashcards
A

Patiromer or Zirconium

23
Q

What is the combination Sacubitril/Valsartan?

Study These Flashcards
A

ARNI: alternative to ACEI or ARB

24
Q

What is a common adverse effect of ARNI therapy?

25
What are common Beta-1 specific antagonists?
Metoprolol and Bisoprolol
26
What is a non-specific beta-blocker with a-1 blocking activity?
Carvedilol
27
What agents are first line for treating Systolic dysfunction?
Mineralocorticoid Receptor Antagonists
28
What Mineralocorticoid antagonists are commonly used?
Spironolactone and Eplerenone
29
What is the benefit of an SGLT2 Inhibitor in Systolic Dysfunction?
Lowers mortality and decreased progression of CKD
30
What is a commonly used SGLT2 inhibitor?
Dapagliflozin
31
What is the role of Digoxin in Systolic Dysfunction?
controls dyspnea
32
What is the role of diuretics in Systolic dysfunction?
Control symptoms
33
What diuretics are commonly used in systolic Dysfunction?
Furosemide, Torsemide, Bumetanide
34
What is the most common cause of death from CHF?
Arrhythmia/sudden death
35
What are the treatment options for Diastolic Dysfunction (HFpEF)?
Spironolactone SGLT2-Inhibitors Diuretics
36
What is Restrictive Cardiomyopathy?
The heart neither contracts nor relaxes normally
37
What causes Restrictive Cardiomyopathy?
Infiltration with substances causing immobility -sarcoidosis -amyloid -hemochromatosis -Endomyocardial Fibrosis -Scledoerma
38
What are common clinical features of Restrictive Cardiomyopathy?
Dyspnea Signs of RHF Pulmonary HTN: from elevated wedge pressure
39
What is the best initial test for Restrictive Cardiomyopathy?
Echocardiogram or cardiogram: showing amyloid with speckling of the septum
40
What is the most accurate test for Restrictive Cardiomyopathy?
Endomyocardial Biopsy
41
What is Pulmonary Edema?
Rapid onset of fluid accumulating in the lungs
42
What are the common symptoms of Pulmonary edema?
Shortness of breath +/- -rales -jvd -S3 gallop -edema -orthopnea
43
What clinical sign is most specific for pulmonary edema?
S3 gallop
44
What lab value can exclude pulmonary edema?
A normal BNP value
45
What is the most importantly test to do acutely in suspected pulmonary edema?
EKG
46
What test should be done in all patients with pulmonary edema?
Echo to assess if there is systolic or diastolic dysfunction
47
What are the treatment strategies for Pulmonary edema?
Preload Reduction Positive Inotropic Agents Afterload Reduction
48
How do you reduce preload in pulmonary edema?
Oxygen Loop diuretic: Furosemide or Bumetanide Remove 1-2L from the vascular space and lungs Nitrates
49
What are commonly use Positive Inotropic agents in pulmonary edema?
Doutamine: only used in the acute setting Amrinone and Milirnone: PDE Inhibitors -increase contractility and decrease afterload Digoxin: only used in the chronic setting: takes several weeks to increase contractility
50
How do you reduce afterload in Pulmonary Edema?
ACEI and ARBs Nitroprusside and IV Hydralazine in the acute setting only

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