COMPLETE QUESTIONS AND ANSWERS.
Systolic CHF. Answer: reduced ejection fraction, problem is with
ejecting
Left sided CHF. Answer: pulmonary (JVD, fluid volume overload,
rails, S-3 murmurs) ** #1 cause of Right sided CHF
BNP. Answer: gold standard lab test to diagnose CHF
Echocardiogram. Answer: Diagnostic tool, evaluates heart structure
and function
At Risk for HF - Stage A. Answer: no structural heart disease or
symptoms of heart failure
Stage A HF co-morbidities. Answer: htn, atherosclerotic disease,
diabetes, metabolic syndrome, patients using cardiotoxins with family
history
, Therapy goals of stage A HF. Answer: treat htn, encourage smoking
cessation, encourage regular exercise, treat lipid disorders, discourage
alcohol intake/drug use, control metabolic syndrome
Meds: ACEI or Angiotensin II RB for vascular disease or diabetes
(avapro, losartan, benicar, diovan, etc)
At Risk for HF - Stage B. Answer: structural heart disease but no
symptoms of heart failure
Stage B HF co-morbidities. Answer: previous MI, LV remodeling
with LV hypertrophy and low EF, asymptomatic valvular disease
Therapy goals of Stage B HF. Answer: Meds: ACEI or ARB, Beta-
blockers, inplantable defibrillators
Stage C heart failure. Answer: structural heart disease with prior or
current symptoms of HF
Presentation of Stage C HF. Answer: known structural heart disease
and shortness of breath and fatigue, reduced exercise tolerance
Therapy for Stage C HF. Answer: dietary salt restriction, MEDS:
diuretic, ACEI, beta blockers. Some patients: aldosterone antagonist,
, ARBs, digitalis, hydralazine/nitrates, biventricular pacing, inplantable
defibrillators
Stage D heart failure. Answer: refractory HF requiring specialized
interventions
Presentation of Stage D HF. Answer: marked symptoms at rest
despite maximal medical therapy (recurrently hospitalized or cannot be
safely discharged without specialized interventions)
Therapy goals for Stage D HF. Answer: compassionate end-of-life
care/hospice, extraordinary measures ,heart transplant, chronic
inotropes, permanent mechanical support, experimental drugs or surgery
Ischemic heart Disease (CAD, MI) presentation. Answer: chest
discomfort, pain in neck/jaw/chest (crushing, squeezing, sharp), pain
worse with exertion (demand requirement is higher), abnormal heart
sounds, hypoxia, arrhythmias (afib, ST elevation)
Stable angina goal. Answer: decrease cardiac oxygen demand
Meds for stable angina. Answer: nitro first choice, then beta blockers
(beta blockers if angina occurs with effort)