heart failure

Question 1

Stroke volume

Answer 1

Amount of blood that is ejected with each beat

Question 2

What factors affect preload

Answer 2

Bradycardia, tachycardia, still lv
Excess volume

Question 3

Most common cause of heart failure

Answer 3

Coronary artery disease
Hypertension 60-90%
Cardiomyopathy,
Congenital heart disease

Question 4

History of heart failure what will pt present with

Answer 4

Dyspnea,
______ orthopnea
________ fatigue
Exercise
Fluid retention
Wt gain

Question 5

Left sided heart failure signs on physical exam r

Answer 5

Dyspnea, on exertion
Crackles in the lungs
Jvd, diminished pulse pressure

Question 6

Right side heart failure physical exam signs

Answer 6

Peripheral pitting edema ! Can be on back and buttocks
GI tract congestion, hepatomegaly, Ascites, decreased apetite
Bendopnea

Question 7

Heart failure ddx

Answer 7

Pulmonary, COPD, pulmonary emboli (Dyspnea, crackles)
______ peripheral edema

Question 8

Workup with heart failure

Answer 8

SpCBC, CMP,
TROPONIN
BNP, >100 and pro BNP >900 is likely heart failure in pt with sob
EKG, lv hypertrophy, prior mi (Q waves) arythmia, tachycardia
Chest xray, pleural effusion (WORSE), Cardiomegaly, bat wing edema, kerley b lines
Echo, assess ejection fraction (normal is >55-65%)

Question 9

Heart failure staging acc, aha based on

Answer 9

Functional classification, progressive, no return to prior stage

Stage A, at risk of heart failure
B, structural disorder, but no symptoms (class. 1 New York heart association)
C, (symptomatic can be under class 2,3,4)
D (worst, advanced, class 4 New York heart)

Question 10

Heart failure 1st management goal

Answer 10

Address causes
Structural, valve repair?
Hypertension

Question 11

SGLT2 recommend in which patient

Answer 11

Pt in stage A at risk for heart failure with risk factor of diabetes and
stage C heart failure with or without diabetes

Question 12

What is entrestro and who is it recommended in

Answer 12

Arb Valsartan, and ARNi
Used for instead of ace or arb

Question 13

What beta blockers are used for in heart failure?

Answer 13

Carvedilol, metoprolol, bisoprolol

Question 14

When is ace used for heart failure? What ace inhibitors are used?

Answer 14

No longer 1st line, used if cannot tolerate ARNI.

Captopril, lisinopril, ramipril

Question 15

Tx of heart failure use what meds initially and what must be titrated

Answer 15

Beta blockers and ARNI or can do ACE OR BB

BB initiate and titrate, till heart rate less than 70 (double dose q2 weeks)

Question 16

When to add diuretics for heart failure

Answer 16

Diuretics are the most effective agents for chronic symptomatic relief

Question 17

If potassium is low what diuretic would u choose

Answer 17

Add on spironolactone, and Eplerone

Question 18

Loop diuretic consist of

Answer 18

Furosemide, bumetanide, toresemide

Question 19

When is a loop initiated

Answer 19

Pt is experiencing symptoms, such as peripheral edema, add on furosemide, or bumetanide, beware gout risk

Question 20

What medication is recommended at a 1st add on for NYHA CLASS II-4 with ef <35%/ creatine clearence >30

Answer 20

Spironolactone, eplerone (aldosterone receptor antagonist]

Question 22

When is digoxin used for heart failure

Answer 22

In a patient with a fib, or failure with improving using other meds

Question 23

What to be weary with using digoxin

Answer 23

Toxicity can occur quickly, look for altered mental status and vision changes, aryhtmia

Question 24

Other treatment options for hf

Answer 24

Fluid restriction, advanced failure
Salt restriction, to decrease fluid retention
Ivabradine, sinus node inhibitor, decrease HR, for stage C EF <35%
Hydralizine, used as an arteriolar dilation, arb preferred
Nitroglycerin, for an acute exacerbation

Question 25

When to consider an lvad for heart failure

Answer 25

Used for low output heart failure, Is used as a bridge to transplant (pt waiting for a heart transplant) Aspirin and warfarin (more likely to get a blood clot) Absent pulse require a Doppler

Question 26

Stage c reduced ef heart failure treatment

Answer 26

ARNI BB DIURETIC, (as needed) loop or thiazide can choose,

Question 27

If pt is a nyha 2-3 heart rate still greater than 70, with a normal sinus rhythm, on max beta blocker, what next to add on?

Answer 27

Ivabradine

Question 28

Pt with reduced ef hf is currently on ARNI, and bb, and diuretic, and egf is low what do u want to add on ?

Answer 28

SGLT2 If stage C always give SGLT2

Question 29

Stage 3-4 New York heart association treatment

Answer 29

Lvad Palliative Transplant

Question 30

What is the Seattle heart failure model,

Answer 30

Used as a prognosis tool. Helps explain to pt the risk vs reward if adding new med is worth it

Question 31

What is etiology of acute decompensated heart failure

Answer 31

Worsening Dyspnea, Usually due to med noncompliance but can be due to an infection or sepsis

Question 32

Physical exam for patient is decompensated heart failure

Answer 32

HYPOXIC, anxious, diaphoretic

Question 33

What to order in acute decompensated heart failure

Answer 33

EKG Chest X-ray, Cardiomegaly Labs, BNP, cbc, troponin Ultrasound, assess for >3 b lines, wall motion abnormalities

Question 34

Elevated BNP in decompensated hf what are other causes of an elevated BNP

Answer 34

PE Sepsis Renal failure

Question 35

The #1 step with treating decompensated heart failure is what ?

Answer 35

Ensure pt is sitting upright, with oxygen, and consider foley

Question 36

Tx for decompensating heart failure involves

Answer 36

Diuretic, furosemide, lasix, given same dose as their daily PO (oral) Nitrates, can be nitroglycerin sublingual, nitroglycerin, paste, nitroglycerin Iv Cpap

Question 37

Peripartum cardiomyopathy cause

Answer 37

Unknown

Question 38

Peripartum cardiomyopathy criteria

Answer 38

Absense of identifiable cause, of pulmonary edema Left systolic dysfunction on echo

Question 39

Risk for Peripartum cardiomyopathy

Answer 39

Older than 30 History preclampsia Cocaine

Question 40

Postpartum tx for pericardiomyopthay

Answer 40

Ace or arb Lasix Spironolactone,

Question 41

Antepartum tx for Peripartum cardiomyopathy

Answer 41

Digoxin, b blocker Hydralizine , lmwh ef <35