OnlineMedEd: Cardiology - "Heart Failure"

Question 1

Right heart failure leads to ________________ edema.

Answer 1

peripheral (JVD, hepatosplenomegaly, and pedal edema)

Question 2

Liver dysfunction from right heart failure is called _____________.

Answer 2

congestive hepatopathy

Question 3

Which side of heart failure causes dyspnea on exertion?

Answer 3

Both!

Left-heart failure causes DOE because of congestion in the lungs. Right-heart failure causes DOE because of inadequate blood flow to the lungs.

Question 4

A _______________ deplaced PMI is suggestive of heart failure.

Answer 4

laterally

Question 5

Describe the diagnostic workup that you should do (and two others that you can do) to evaluate heart failure.

Answer 5

• Should do:

• BNP
• Echo (look for EF, pulmonary BP, diastolic or systolic structural changes)
• Left-heart catheter

•Can do:

• Chest x-ray
• ECG

Question 6

Review the New York Heart Association classes.

Answer 6

• I: no symptoms
• II: symptoms with moderate exertion
• III: symptoms with mild exertion
• IV: symptoms at rest

Question 7

Explain the treatment tiers of heart failure.

Answer 7

• I: beta-blocker, ACEi
• II: beta-blocker, ACEi, furosemide
• III: beta-blocker, ACEi, furosemide, spironolactone or isosorbide dinitro-hydralazine
• IV: beta-blocker, ACEi, furosemide, spironolactone or isosorbide dinitro-hydralazine, inotropes/transplant

Question 8

What lifestyle recommendations are recommended for all heart failure patients?

Answer 8

• Smoking cessation
• Fluid restriction to less than 2 L/day
• Salt restriction to less than 2 g/day

Question 9

Describe the workup of CHF exacerbations.

Answer 9

• First, do a CXR, ECG, troponins, and BNP to evaluate what is going on.
- If those tests are negative, consider other causes.
- If the patient is having a STEMI, then take them to the cath lab.
•Second, if tests show that the person is having an exacerbation of their CHF, then treat with LMNOP.

Question 10

CHF exacerbations should be treated with _______________.

Answer 10

LMNOP: 
•Lasix
•Morphine
•Nitrates
•Oxygen
• Position 

CHF exacerbations are caused by volume overload leading to hypoxemia. You need to get the fluid off and supply more O2 in the meantime. Nitrates dilate the veins and prevent excessive pulmonary congestion. Positioning does the same.