Heart Failure Review Flashcards

A set of 45 vocabulary flashcards covering heart failure categories, causes, symptoms, diagnostics, and pharmacological treatments based on the lecture notes.

Most common cause of HFrEF

Ischemic heart disease.

Most common cause of HFpEF

Hypertension.

HFrEF Ejection Fraction cutoff

A measurement of $\le 40\%$.

BNP (Brain Natriuretic Peptide)

A hormone released due to ventricular stretch.

The first-line medication used for fluid overload in heart failure.

Loop diuretic

Four pillars of HFrEF therapy

ARNI (/ACE/ARB), beta blocker, MRA, and SGLT2 inhibitor.

ACE Inhibitor Adverse Effects

Cough, hyperkalemia, and angioedema.

Spironolactone Adverse Effects

Hyperkalemia and gynecomastia.

Beta blockers proven to reduce mortality in Heart Failure

Carvedilol, metoprolol succinate, and bisoprolol.

When should beta blockers be avoided in heart failure

Acute decompensated Heart Failure

SGLT2 inhibitors provide benefits for which type of heart failure

Both HFrEF and HFpEF

Digoxin toxicity symptoms and treatment

Visual disturbance, nausea, arrhythmias; activated charcoal

HF medications contraindicated in pregnancy

ACE inhibitors, ARBs, and ARNI.

Classic CXR finding in Heart Failure

Pulmonary vascular congestion (kerley B lines, etc), cardiomegaly, pleural effusion

Acute decompensated HF pulmonary edema treatment

A combination of diuretics, oxygen, and nitrates (if the patient is hypertensive).

A condition in which BNP levels may be falsely low.

Obesity

Conditions in which BNP levels may be elevated (other than HF)

Renal failure, atrial fibrillation, COPD, ARDS, sepsis, liver cirrhosis, hyperthyroidism, chemotherapy.

Most common cause of Right Heart Failure

Left heart failure.

RAAS activation effect on Heart Failure

Promotes sodium retention and cardiac remodeling.

ARNI for Heart Failure

Sacubitril/ valsartan.

MOA and use of Ivabradine

Reduces rate of SA node; use in HFrEF sinus rhythm with HR still >70 bpm on maximum tolerated beta blocker

HFpEF mechanism

Diastolic dysfunction (CO dependent on preload)

HFrEF mechanism

Systolic dysfunction.

Classic description of sputum in pulmonary edema.

Pink frothy sputum

Most common arrhythmia in chronic HF

Atrial fibrillation

Goal of diuretics in HF

Mainly for symptom relief. No proven mortality benefit

Best diagnostic test/imaging study for HF

Echocardiogram

What electrolyte needs monitoring with ACEi and MRA use

Potassium

How do most HF meds work

Blocking maladaptive neurohormonal activation like RAAS

Breathing pattern associated with advanced Heart Failure

Cheyne-Stokes respirations.

Does elevated BNP diagnose Heart Failure

Supports but is nonspecific

Digoxin toxicity and electrolyte monitoring

Hypokalemia most critical, promotes binding to myocardial cell membrane; also monitor serum creatinine as drug primarily excreted by kidneys

NSAIDs and HF

Contraindicated, can worsen symptoms ie fluid retention

What class of diabetes medication is contraindicated in HF

Thiazolidinediones ie pioglitazone & rosiglitazone

Pulmonary artery wedge pressure

Measurement used to indirectly estimate left atrial pressure and left ventricular end-diastolic pressure, essential for determining if pulmonary edema is due to cardiac or non-cardiac cause (high indicates cardiac cause)

How to measure pulmonary artery wedge pressure

Swanz-Ganz catheter.

What diabetic drug should be avoided in acute decompensated HF

Metformin, due to risk of lactic acidosis (increased risk from tissue hypoxia).

High output heart failure

Condition where the heart pumps an adequate volume of blood but cannot meet the body's demands (hyperdynamic state).

Causes of high output heart failure

Hyperthyroidism, beriberi, AV fistula, Paget disease, severe anemia, pregnancy.

Low output Heart Failure

Condition characterized by inadequate cardiac output, leading to insufficient blood supply to meet the body's needs.

Causes of low output heart failure.

Most commonly caused by decreased EF, dilated cardiomyopathy, chronic HTN, valvular heart disease.

Red flags in weight monitoring in HF

Rapid weight gain is defined as 2-3 lbs in 24 hours or 5 lbs in 1 week.

Preload dependent states in which nitroglycerin should be avoided.

Aortic stenosis, volume depletion/ hypotension, RV infarct, hypertrophic cardiomyopathy (HCM).

Risk factors for CHF.

Smoking, alcohol, PMH cardiomyopathy, familial heart disease, rheumatic heart disease, hyperthyroidism, dyslipidemia, diabetes mellitus (DM), HTN, sleep apnea, peripheral arterial disease (PAD), substance use, chemo or radiation to the chest.

Physical exam findings in HFrEF

Pulsus alternans (alternating strong and weak peripheral pulses), laterally displaced apical impulse, S3 heart sound, elevated jugular venous pressure.

Pulmonary edema lung auscultation.

Crackles/ rales that do not clear with coughing.

What is the most sensitive/ specific exam finding with best positive and negative predictive value in HFrEF

Displaced apical impulse (normally 5th intercostal space).