Heart Failure Flashcards
(32 cards)
Frequent nocturnal hypoxemia in a patient with normal BMI and advanced heart failure suggests possible central sleep apnea.
Central sleep apnea
CSA in HF is characterized by Cheyne-Stokes breathing, oscillating tidal volume with hyperventilation the periods of hypopnea, and apnea.
Management of HFpEF?
Specific therapies to reduce hospitalization and possibly mortality:
• MRAs (eg, spironolactone)
• SGLT-2 inhibitors (eg, dapagliflozin)
Treat Afterload reduction (blood pressure <130/80 mm Hg)- anti hypertensives
Spiranolactone
Treat volume overload -Diuretics
Treat exacerbating causes (a fib - rate control, CAD-coronary revascularization treat exacerbating conditions.)
Exercise training and cardiac rehab
Indications for CRT?
Biventricular pacemaker is indicated for
Symptomatic🤕 ➕(LVEF) <35% ➕LBBB with QRS duration > 1️⃣5️⃣0️⃣
However, patient should first receive OPTIMAL medical therapy for at least 3️⃣ months to evaluate for LVEF recovery ❤️🩹 😤
Goal: Improve heart function, reduce symptoms, and decrease mortality.
When is an ICD indicated ?
What can patients get in the interim?
What if the patient doesn’t undergo PCI ?
Place an ICD in patients with persistent LVEF <30% (or <35% with heart failure symptoms) on repeat evaluation 3️⃣ months after revascularization.
Temporary wearable cardiac defibrillator (LifeVest) during this period.
Reassessed for ICD placement 4️⃣0️⃣ days after a myocardial infarction.
- What defines HFrEF?
- What defines HFpEF?
3.What defines heart failure with mid-range EF?
- EF ≤40%.
- ≥50%
3.LVEF >40% and <50%.
Most common cause of HFpEF?
Hypertension
Ventricular remodeling in HFrEF vs HFpEF?
HFrEF: Dilated ventricles
HFpEF: Normal-sized ventricles or Concentric Hypertrophy
Symptoms and signs that increase likelihood of heart failure?
Paroxysmal nocturnal dyspnea (>2x likelihood)
Presence of S3 (11x likelihood)
- BNP level arguing against heart failure?
- What level suggest?
- BNP <100 pg/mL
- BNP > 400 pg/mL
- How can obesity affect BNP levels?
- What about CKD?
- Obesity lowers BNP levels
- CKD can increase it
What initial tests help diagnose heart failure?
ECG, chest x-ray, echocardiography.
When is cardiac MRI (CMR) used in heart failure?
When suspecting Myocarditis or Infiltrative disease (e.g., amyloidosis).
When is endomyocardial biopsy indicated?
Rarely — for suspected giant cell myocarditis or cardiac sarcoidosis.
When is a Sleep Study recommended in heart failure?
In NYHA class II-IV HFrEF with excessive Daytime Sleepiness.
- First-line medications for all NYHA classes in HFrEF?
- What medication can substitute ACE/ARB
- Medication for Class III
- ACE inhibitors (or ARBs if intolerant)
- Valsartan-sacubitril (ARNI)
- Spiranolactone
Who should receive Hydralazine + Nitrates in HFrEF?
Patients who cannot tolerate ACEI/ARB, (elevated CR) or those with low output.
Which β-blockers are proven to reduce mortality in HFrEF?
- Metoprolol Succinate -Sucks not to be on it
- Carvedilol
- Bisoprolol
When are aldosterone antagonists (spironolactone/eplerenone) indicated?
Class III
Role of digitalis (digoxin) in HFrEF?
Symptom Control when there is Persistent Symptoms despite GMDT.
Ivabradine indications?
EF ≤35%, Sinus rhythm, HR ≥70/min despite Maximal β-blocker therapy
It Helps slow down the stress of the heart.
Role of SGLT2 inhibitors (dapagliflozin, empagliflozin) in HFrEF?
Reduce Cardiovascular Death + Hospitalizations
When is Cardiac Resynchronization Rherapy (CRT) indicated (an ICD)?
NYHA class II–IV, LVEF ≤35%, LBBB with QRS >150 ms, sinus rhythm.
Additional NON-Drug therapy for all HF patients?
Exercise Training- Cardiac Rehabilitation
Which medications should be Avoided in HF?
NSAIDs
Thiazolidinediones
Nondihydropyridine CCBs (diltiazem, verapamil)
