Chronic Heart Failure

heart failure

tachycardia, tachypnea, rales, pleural effusion, raised JVp, peripheral edema, and hepatomegaly are the signs of __________

heart failure

breathlessness, orthopnea, paroxysmal nocturnal dyspnea, reduced exercise tolerance, fatigue, weight gain, and weight loss are symptoms of _________

HFrEF

systolic heart failure; ejection fraction <40%

HFpEF

diastolic heart failure; ejection fraction >50%

HFmrEF

LVEF 41-49%; elevated natiruretic peptides

HFimpEF

individuals with previous LVEF <40 and a follow up measurement of LVEF >40%

coronary heart disease

what is most common etiology for heart failure

true

true or false: higher NSAID dose causes higher risk for heart failure

heart failure

being a male of black race leads to higher risk of __________

HFpEF

secondary (hypertension) and aging are the main causes of which type of heart failure

HFrEF

coronary artery disease, myocardial infarction, and myocardial ischemia are the main causes of which type of heart failure

stretch

Brain natriuretic peptide is produced by the ventricular myocardium in response to __________

BNP causes _________ (vasodilation/vasoconstriction) and natriuresis

angiotensin II and aldosterone

what does BNP counteract

optimize stroke volume

What is the purpose of increased preload in heart failure compensation

CO

vasoconstriction helps maintain BP in face of reduced _________

CO

tachycardia and increased contractility helps maintain _____

CO, myocardial infarction

ventricular hypertrophy and remodeling helps maintain ____ and reduces ______ wall stress

edema

increased preload can cause pulmonary system congestion and ________ formation

diastolic

tachycardia shortens _______ filling time

diastolic and systolic

ventricular hypertrophy and remodeling causes _______ (diastolic/systolic) dysfunction

contractility

NE release helps to maintain ________

contractility

systolic dysfunction causes impaired ________

filling

diastolic dysfunction has impaired _________

systolic

_______ dysfunction has thin/weak heart muscle and low ejection fraction

diastol

______ dysfunction has stiff/thick heart muscle with normal ejection fraction

diastolic

which dysfunction (diastolic/systolic) has limiited CO

dyspnea and fatigue

what is initial clinical presentation of heart failure

10 pound

typically a _______ fluid weight gain precedes trace edema

false (no gold standard)

true or false: angiography is the gold standard for diagnosis of HF

echocardiogram

what is the most useful test to assess cardiac abnormalities

NYHA

which classification of heart failure CAN move up or down the categories

ACCF/AHA

which classification of heart failure CANNOT move up or down the categories

A

which ACCF/AHA classification of heart failure is this: at high risk for HF, but without structural heart disease or symptoms of HF

B

which ACCF/AHA classification of heart failure is this: structural heart disease but without signs or symptoms of HF

C

which ACCF/AHA classification of heart failure is this: structural heart disease with prior or current symptoms of HF

D

which ACCF/AHA classification of heart failure is this: refractory HF requiring specialized interventions

I

which NYHA classification of heart failure is this: no limitation of physical activity. ordinary physical activity does not cause symptoms of HF

II

which NYHA classification of heart failure is this: slight limitation of physical activity. Comfortable at rest, but ordinary physical activity causes symptoms of HF

III

which NYHA classification of heart failure is this: marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes symtpoms of HF

IV

which NYHA classification of heart failure is this: unable to carry on any physical activity without symptoms of HF or symptoms of HF at rest

diuretic

in outpatient treatment of HF, which therapy (give drug class) is used to relieve fluid retention to decrease preload without increasing CO

loop diuretics

which type of diuretic is used in outpatient setting of HF

vasodilators

in outpatient treatment of HF, which drug class reduces preload and decreases pulmonary congestion, ventricular size/wall stress, and myocardial oxygen demand

arterial

________ vasodilators reduce afterload and decrease BP and increase CO

digoxin

this treatment in the outpatient setting has a positive inotropic effect and increases CO, decreases PCWP and SVR, and increases LVEF

false

true or false: digoxin reduces mortality

true

true or false: digoxin reduces signs and symptoms of heart failure

diuretics, vasodilators, and digoxin

what are the three drugs/drug classes that are used to RELIEVE symptoms of HF (do not reduce mortality)

ACEi/ARBs, aldosterone antagonists, beta blockers, SGLT2i

which drug classes are morbidity and mortality reducers (5)

Ace inhibitors

which morbidity/mortality reducer of HF is this:

- arterial and venous vasodilation (reduce preload, decrease SBR and BP, increase CO, decrease oxygen demand)

- imrpoves symtpoms

- inhibits LV remodeling

- improves survival, decreases hospitalizations, improves quality of life

ARBs

which morbidity and mortality reducer is this:

- reduce BP, decrease afterload, possibly reduce vascular hypertrophy and atherosclerosis and reduce LB hypertrophy

aldosterone antagonists

which morbidity and mortality reducer is this:

- reduce cardiac firbosis and ventricular remodeling

- attenuate aldosterone-induced inflammation, atherogenesis, and oxidative stress

- improve symptoms, reduce hospitalizations, improved survival

beta blocker

which morbidity and mortality reducer is this:

- negative inotropic effects and reduced HR

- inhibit cardiotoxicity of catecholamines

- decrease neurohormonal activation, heart rate, and BP

- antiarrhythmic, antioxidant, antiproliferative

SGLT2 inhibitors

which morbidity and mortality reducer is this:

- promote osmotic diuresis and natriuresis (reduces preload)

- possible vascular effects that promote vasodilation (reduce afterload)

- may improve cardiac efficiency through increased myocardial metbaolism

vericiguat

what is the soluble guanylate cyclase stimulator

<1500 mg

per HTN guidelines, what should sodium restriction be

D

fluid restriction is reserved for patients with stage ___ HF who ahve severe hyponatremia or diuretic resistance

CPAP

this nonpharm recommendation is used to increase LVEF and improve functional status in patients w/ HF and sleep apnea

cardiac rehabilitation

this nonpharm recommendation is used in stable patients with HF to improve functional capacity, exercise duration, and mortality

SGLT2 inhibitor

in stage A HF, control HTN and lipid disorders to lower risk of HF and use ___________ in diabetes if clinical ascvd or high ascvd risk

ACEi, beta blockers, and statins

which medications should be started in patients with stage B HF

carvedilol, metoprolol succinate, and bisoprolol

which beta blockers are used in heart failure

NON dihydropyridine CCBs

in patients with stage B HF, what should be avoided in patients with EF <50%

thiazolidenidiones

in stage B HF, avoid __________ (diabetic med) due to increased risk of HF and hospitalizations

ARNI

which of the following is preferred in stage C HFrEF:

- ARNI/ACEi/ARB

loop diuretic

what should be added for patiets with fluid retention in stage C HFrEF

ARBs

_____ are for patients intolerant to ACEi to reduce morbidity and mortality

ARNI

in patients with chronic symptomatic HFrEF NYHA class II or III who tolerate an ACEi or ARB, replacement by an _______ is recommended to further reduce morbidity and mortality (class Ib recommendation)

36hrs

ensure ______ OFF ACEi, edquate BP, and eGFR of 30ml/min or higher BEFORE starting an ARNI

aldosterone antagonists

this is for patients with NYHA class II-IV AND LVEF <35% to reduce morbidity and mortality

5

before starting aldosterone antagonist, potassium should be less than _______

SGLT2 inhibitors

this should be added for patients with NYHA class II-IV REGARDLESS of diabetes status

30

eGFR needs to be greater than _____ for dapagliflozin

20

eGFR needs to be greater than ________ for empaglizolin

hydralazine and isosorbide dinitrate

this should be added in african american patients with NYHA class II-IV receiving optimal acei, BBs, aldosterone antagonist, and SGLT2 inhibitor

aldosterone antagonists

_______ for patients in stage C HFrEF after heart failure related hospitalizations with HFrEF, who have HF symptoms or who have diabetes tor educe morbidity and mortality

ivabradine

_______ can be beneficial to reduce HF hospitalizations for patients with symptomatic (NYHA class II-III) stable chronic HFrEF (LVEF <35%) who are recing GDMT

digoxin

this can be used to decrease hospitalizations in stage C HFrEF

fish oil

this is reasonable to use as ADJUNCTIVE therapy in patients with NYHA class II-IV and HFrEF or HFpEF to reduce mortality and hospitalizations

vericiguat

for high risk patiens already on optimal GDMT with worsening HF as evidenced by a HF hospitalization for requirement for intravenous diuretics

ivabradine

for patietns with resting HR >70, on maximally tolerated beta blocker dose in sinus rhythm NYHS class II-III

2 weeks

consider increasing dose of beta blocker every ________ until maximum tolerated or target dose is achieved

D

what stage of heart disease is this: specialized, advanced treatment strategies, including MCS &LVAD, procedures to facilitate fluid removal, continuous inotropic infusions, or cardiac transplantation, or hospice

SGLT2i

what medication should everyone with HFpEF be on

loop diuretic

what should be added to HFpEF patient with fluid retention

mineralocorticoid receptor antagonist

what should be added to HFpEF treatment for all women and men with EF <55-60%, those with fluid retention

ARNI

what should be added to HFpEF treatment for women (all EFs), men with LVEF <55-60%

ARB

what should be added for HFpEF treatment for ARNI-eligible individuals who cannot take due to cost or intolerance

aldosterone antagonists

this can be added to HFpEF treatment to reduce hospitalizations if elevated BNPP or HF hospitalization within 1 year, eGFR >30, SCr <2.5, potassium <5