24 Questions
What is the formula for cardiac output?
CO = HR × SV
What is the primary symptom of heart failure with reduced ejection fraction?
Dyspnea on exertion
What is the usual ejection fraction in heart failure with reduced ejection fraction?
50%
Which of the following is a cause of systolic dysfunction?
All of the above
What is the best management for a patient with heart failure and orthopnea?
Add Hydrochlorothiazide
What is the NYHA classification of the patient in Case #1?
NYHA III
What is the goal of pharmacologic management in heart failure with reduced ejection fraction?
To control blood pressure and volume overload
What happens in left-sided heart failure?
Blood cannot be adequately pumped from LV to periphery, accumulating in the LV and backing up into lungs
What is a characteristic of right-sided heart failure?
Systemic edema
What is a common non-specific symptom of heart failure with reduced ejection fraction?
Fatigue
Which of the following is a recommended pharmacologic treatment for heart failure with reduced ejection fraction?
Anticoagulation for patients with HF who have permanent, persistent, or paroxysmal AF with an additional risk factor for stroke
What is the preferred term for the condition where the heart is unable to fill or eject blood?
Heart Failure
What is the recommendation for nondihydropyridine calcium channel blockers in patients with a low EF?
Should be avoided due to negative inotropic effects
What is the preferred antiarrhythmic in patients with HFrEF?
Dofetilide
What is the normal range of Left Ventricular Ejection Fraction (LVEF)?
55% or higher
What is the classification of Heart Failure with an Ejection Fraction of 35%?
Heart Failure with Reduced Ejection Fraction (HFrEF)
What is the role of device therapy in heart failure?
The information about device therapy is not provided
Why can amlodipine be considered for use in heart failure patients?
It has neutral effects on morbidity and mortality in HF
What is the leading cause of Heart Failure with Reduced Ejection Fraction (HFrEF)?
Coronary Artery Disease
What percentage of Heart Failure cases are attributed to nonischemic cardiomyopathy?
One third
What is the recommendation for anticoagulation in patients with HF who have permanent, persistent, or paroxysmal AF without an additional risk factor for stroke?
It is reasonable for these patients
What is the term for Heart Failure caused by conditions that place a great demand on the heart?
Heart Failure due to Increased Demand
What is the common characteristic of conditions that lead to Heart Failure with Reduced Ejection Fraction (HFrEF)?
They all place a great demand on the heart
What is the term for the type of Heart Failure that is previously known as Systolic Heart Failure?
Heart Failure with Reduced Ejection Fraction (HFrEF)
Study Notes
Heart Failure
- Heart failure is a complex, progressive clinical syndrome caused by any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood.
Regulation of Cardiac Output
- Cardiac output (CO) is regulated via ejection impedance, wall tension, and regional wall geometry.
- Contractility is influenced by adrenergic activity and circulating catecholamines.
Types of Heart Failure
- Left-sided heart failure: blood cannot be adequately pumped from the left ventricle (LV) to the periphery, accumulating in the LV, leading to pulmonary edema.
- Right-sided heart failure: blood cannot be pumped from the right ventricle (RV) to the lungs, accumulating in the RV, leading to systemic edema.
HFrEF (Heart Failure with Reduced Ejection Fraction)
- Definition: heart failure with an ejection fraction (EF) ≤ 40%.
- Pathophysiology: decreased contractility, influenced by adrenergic activity and circulating catecholamines.
- Causes: coronary artery disease, hypertension, nonischemic cardiomyopathy, myocarditis, idiopathic, tachycardia, and peripartum.
HFrEF Algorithm
- Algorithm for pharmacologic management of heart failure with reduced ejection fraction.
- Guideline-directed treatment algorithm for patients with ACC/AHA stage C heart failure with reduced ejection fraction.
Pharmacologic Management
- Anticoagulation: recommended for HF with permanent, persistent, or paroxysmal AF with an additional risk factor for stroke.
- Statins: not recommended solely on the basis of HF diagnosis.
- Antiarrhythmics: dofetilide and amiodarone are preferred for patients with HFrEF.
- Nondihydropyridine calcium channel blockers (CCBs) with negative inotropic effects can be harmful in patients with a low EF and should be avoided.
Clinical Presentation
- Primary symptoms: dyspnea (especially on exertion), fatigue, and exercise intolerance.
- Other symptoms: orthopnea, paroxysmal nocturnal dyspnea, tachypnea, cough, fluid overload, and peripheral edema.
- Nonspecific symptoms: fatigue, nocturia, hemoptysis, abdominal pain, anorexia, nausea, bloating, ascites, poor appetite, and weight gain or loss.
Diagnosis
- Assessment of fluid status.
- Assessment of ejection fraction (usually < 50%).
Case Study
- Ms. L, a 75-year-old with heart failure (NYHA III) and atrial fibrillation, is on Captopril, Bisoprolol, and Furosemide.
- The best management for this patient is to increase the dose of Bisoprolol to 25 mg bid.
This quiz covers the complex clinical syndrome of heart failure, its causes, and the regulation of cardiac output. It also explores the different types of heart failure.
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