Heart Failure Classification

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Questions and Answers

What is the recommended primary prevention of sudden cardiac death in patients with ischemic or nonischemic HFrEF?

Implantable cardioverter defibrillator with a Beta blocker

Implantable cardioverter defibrillator with an angiotensin-converting enzyme inhibitor

Nondihydropyridine calcium channel blockers with negative inotropic effects

Implantable cardioverter defibrillator in patients with LVEF of 35% or less and NYHA class II or III symptoms (correct)

What is the class III recommendation in patients with a low EF?

Use of implantable cardioverter defibrillator for primary prevention of sudden cardiac death

Use of dofetilide for AF/atrial flutter

Use of amlodipine for HTN or ischemic heart disease management

Use of nondihydropyridine calcium channel blockers with negative inotropic effects (correct)

What is the benefit of using DHP CCBs in HF patients?

They are contraindicated in HF patients

They have a proven benefit on morbidity or mortality in HF

They are recommended for primary prevention of sudden cardiac death

They have neutral effects on morbidity and mortality in HF (correct)

What is the recommended therapy for those with an LVEF of 35% or less, in SR, and a left bundle branch block with a QRS of 150 milliseconds or greater?

Chronic resynchronization therapy Signup and view all the answers

What is the life expectancy requirement for implantable cardioverter defibrillator recommendation?

Greater than 1 year Signup and view all the answers

What is the preferred antiarrhythmic in patients with HFrEF for AF/atrial flutter?

Dofetilide Signup and view all the answers

What is the New York Heart Association (NYHA) classification of the patient's heart failure?

NYHA II Signup and view all the answers

What is the patient's left ventricular ejection fraction (LVEF)?

25% Signup and view all the answers

What is the patient's American College of Cardiology (ACC) and American Heart Association (AHA) heart failure classification?

ACC/AHA C Signup and view all the answers

Which medication is recommended for the patient's heart failure with reduced ejection fraction?

Carvedilol Signup and view all the answers

What is the goal of the Guideline-Directed Treatment (GDT) algorithm for patients with heart failure with reduced ejection fraction?

To maximize the management of heart failure Signup and view all the answers

What is the patient's heart failure caused by?

All of the above Signup and view all the answers

What is the recommended anticoagulation therapy for the patient's heart failure?

Either warfarin or a direct oral anticoagulant (DOAC) Signup and view all the answers

What is the role of statins in the patient's heart failure management?

Not recommended solely on the basis of heart failure diagnosis Signup and view all the answers

What is the primary symptom of heart failure, leading to exercise intolerance?

Dyspnea Signup and view all the answers

Which of the following is a cause of systolic dysfunction?

All of the above Signup and view all the answers

What is the typical ejection fraction in heart failure with reduced ejection fraction (HFrEF)?

Less than 50% Signup and view all the answers

What is the best approach to maximize the management of heart failure in a patient with NYHA class III?

Add Ivabradine 5 mg BID Signup and view all the answers

What is the NYHA classification of a patient with marked limitation to physical activity and less than ordinary activity resulting in fatigue and palpitation?

NYHA class III Signup and view all the answers

What is the primary goal of heart failure management?

Control BP and volume overload Signup and view all the answers

What is the formula for cardiac output?

CO = HR × SV Signup and view all the answers

What is the assessment of fluid status important for in heart failure diagnosis?

Evaluating volume overload Signup and view all the answers

The patient's heart failure is classified as NYHA III and ACC/AHA C.

False Signup and view all the answers

The patient's left ventricular ejection fraction (LVEF) is 40%.

False Signup and view all the answers

Heart failure is primarily caused by hypertension in this patient.

False Signup and view all the answers

The patient's symptoms are consistent with NYHA class I.

False Signup and view all the answers

The patient's heart failure is classified as ACC/AHA stage A.

False Signup and view all the answers

The patient's heart failure is caused by hypothyroidism.

False Signup and view all the answers

The patient's ejection fraction is typical of heart failure with preserved ejection fraction (HFpEF).

False Signup and view all the answers

The patient's symptoms are consistent with NYHA class IV.

False Signup and view all the answers

The formula for cardiac output is CO = HR × SV.

True Signup and view all the answers

Cocaine is a known cardiotoxin that can cause heart failure.

True Signup and view all the answers

Chemotherapeutic agents are a cause of systolic dysfunction.

True Signup and view all the answers

The clinical presentation of heart failure with reduced ejection fraction (HFrEF) always includes severe symptoms.

False Signup and view all the answers

Ejection fraction is typically less than 50% in heart failure with reduced ejection fraction (HFrEF).

True Signup and view all the answers

Assessment of fluid status is important for diagnosing heart failure.

True Signup and view all the answers

Orthopnea is a common symptom of heart failure.

True Signup and view all the answers

Alcohol is a known cause of systolic dysfunction.

True Signup and view all the answers

The term 'heart failure' is preferred over 'congestive heart failure' because all patients present with volume overload.

False Signup and view all the answers

An LV ejection fraction of 40% or lower is considered normal.

False Signup and view all the answers

Heart failure with reduced ejection fraction is also known as diastolic heart failure.

False Signup and view all the answers

Hypertension is the leading cause of heart failure.

False Signup and view all the answers

One third of heart failure cases are attributable to nonischemic cardiomyopathy.

True Signup and view all the answers

Heart failure is a complex clinical syndrome caused by any structural or functional cardiac disorder that impairs the ability of the atria to fill or eject blood.

False Signup and view all the answers

Ejection fraction is usually measured only in the right ventricle.

False Signup and view all the answers

Heart failure with preserved ejection fraction is characterized by an EF of 40% or lower.

False Signup and view all the answers

What is the term preferred over 'congestive heart failure' and why?

The term 'heart failure' is preferred over 'congestive heart failure' because not all patients present with volume overload. Signup and view all the answers

What is the normal range of ejection fraction in the left ventricle?

An LV ejection fraction of 55% or higher is considered normal. Signup and view all the answers

What is the primary cause of heart failure with reduced ejection fraction?

Coronary artery disease and hypertension are the leading causes of heart failure. Signup and view all the answers

What is the characteristic of heart failure with preserved ejection fraction?

Heart failure with preserved ejection fraction (HFpEF) is characterized by an EF ≥ 50%. Signup and view all the answers

What is the pathophysiological definition of heart failure?

Heart failure is a complex clinical syndrome caused by any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood. Signup and view all the answers

What is the significance of assessing fluid status in heart failure diagnosis?

Assessment of fluid status is important for diagnosing heart failure. Signup and view all the answers

What is the common symptom associated with heart failure?

Orthopnea is a common symptom of heart failure. Signup and view all the answers

What is the proportion of heart failure cases attributable to nonischemic cardiomyopathy?

One third of heart failure cases are attributable to nonischemic cardiomyopathy. Signup and view all the answers

What is the formula for cardiac output, and what do the variables represent?

CO = HR × SV, where CO is cardiac output, HR is heart rate, and SV is stroke volume. Signup and view all the answers

What are the primary symptoms of heart failure with reduced ejection fraction (HFrEF)?

Dyspnea (especially on exertion) and fatigue, which lead to exercise intolerance. Signup and view all the answers

What is the typical ejection fraction in heart failure with reduced ejection fraction (HFrEF)?

Less than 50%. Signup and view all the answers

What is the importance of assessing fluid status in heart failure diagnosis?

It helps diagnose heart failure and guides management. Signup and view all the answers

What are some common causes of systolic dysfunction?

Cardiotoxins, such as alcohol and cocaine, and chemotherapeutic agents. Signup and view all the answers

What is the pathophysiological explanation for the symptoms of heart failure?

Decreased contractility, leading to decreased cardiac output, and fluid overload, resulting in symptoms such as dyspnea and fatigue. Signup and view all the answers

What is the significance of orthopnea in heart failure?

It is a common symptom of heart failure, often resulting in difficulty sleeping. Signup and view all the answers

What is the goal of management in heart failure with reduced ejection fraction?

To control BP and volume overload, and to improve symptoms. Signup and view all the answers

What is the typical ejection fraction in heart failure with reduced ejection fraction (HFrEF)?

Less than 50% Signup and view all the answers

What is the primary cause of heart failure in this patient?

CHD (MI 3 years ago) Signup and view all the answers

What is the primary symptom of heart failure, leading to exercise intolerance?

Fatigue Signup and view all the answers

What is the importance of assessing fluid status in heart failure diagnosis?

To diagnose heart failure Signup and view all the answers

What is the pathophysiological mechanism underlying heart failure?

Impaired ability of the atria to fill or eject blood Signup and view all the answers

What is the clinical presentation of heart failure with reduced ejection fraction (HFrEF)?

Marked limitation to physical activity, fatigue, and palpitation Signup and view all the answers

What is the role of hypertension in heart failure?

Leading cause of heart failure Signup and view all the answers

What is the New York Heart Association (NYHA) classification of the patient's heart failure?

NYHA II Signup and view all the answers

The formula for cardiac output is CO = ______ × SV.

HR Signup and view all the answers

Chemotherapeutic agents are a known cause of ______ dysfunction.

systolic Signup and view all the answers

Ejection fraction is typically less than ______ % in heart failure with reduced ejection fraction.

50 Signup and view all the answers

The patient's heart failure classification is NYHA II and ACC/AHA ______.

B Signup and view all the answers

Assessment of fluid status is important for ______ heart failure.

diagnosing Signup and view all the answers

The patient's left ventricular ejection fraction (LVEF) is ______%.

25 Signup and view all the answers

Primary symptoms of heart failure include ______ and fatigue.

dyspnea Signup and view all the answers

The patient's heart failure is caused by ______ and others.

CHD Signup and view all the answers

Cocaine is a known ______ that can cause heart failure.

cardiotoxin Signup and view all the answers

The symptoms of heart failure leading to exercise intolerance are primarily due to ______.

systolic dysfunction Signup and view all the answers

Alcohol is a known cause of ______ dysfunction.

systolic Signup and view all the answers

The patient's heart failure is classified as NYHA ______ and has symptoms of orthopnea and fatigue.

III Signup and view all the answers

The assessment of ______ status is important for diagnosing heart failure.

fluid Signup and view all the answers

Hypertension is a known ______ that can cause heart failure.

cardiotoxin Signup and view all the answers

The patient's heart failure is classified as heart failure with ______ ejection fraction.

reduced Signup and view all the answers

The term 'heart failure' is preferred over 'congestive heart failure' because not all patients present with ______ overload.

volume Signup and view all the answers

Heart failure is a complex clinical syndrome caused by any structural or functional cardiac disorder that impairs the ability of the ___________ to fill or eject blood.

ventricle Signup and view all the answers

The term 'heart failure' is preferred over 'congestive heart failure' because not all the patients are presented with ___________ overload.

volume Signup and view all the answers

An LV ejection fraction of ___________ percent or higher is considered normal.

55 Signup and view all the answers

The leading causes of heart failure are ___________ artery disease and hypertension.

coronary Signup and view all the answers

One third of heart failure cases are attributable to ___________ cardiomyopathy.

nonischemic Signup and view all the answers

Ejection fraction is usually measured only in the ___________ ventricle.

left Signup and view all the answers

Heart failure with reduced ejection fraction is characterized by an EF of ___________ percent or lower.

40 Signup and view all the answers

Any condition that places a great demand on the heart will result in heart failure, such as ___________ and obesity.

hypertension Signup and view all the answers

Match the following cardiotoxins with their corresponding effects on the heart:

Alcohol = Causes systolic dysfunction Cocaine = Causes systolic dysfunction Chemotherapeutic agents = Causes systolic dysfunction CSS = Not a cardiotoxin Signup and view all the answers

Match the following heart failure clinical presentations with their corresponding symptoms:

Dyspnea = Shortness of breath, especially on exertion Fatigue = Lack of energy, leading to exercise intolerance Orthopnea = Shortness of breath when lying down Nocturia = Urinating frequently at night Signup and view all the answers

Match the following heart failure diagnosis assessments with their corresponding purposes:

Assessment of fluid status = Determine volume overload Assessment of ejection fraction = Determine systolic dysfunction BP control = Control hypertension Volume overload control = Reduce fluid buildup Signup and view all the answers

Match the following heart failure pathophysiology concepts with their corresponding formulas:

Cardiac output = CO = HR × SV Stroke volume = The volume of blood ejected with each systole Heart rate = The number of heartbeats per minute Ejection fraction = The percentage of blood ejected from the ventricle Signup and view all the answers

Match the following heart failure causes with their corresponding effects on the heart:

Hypertension = Increases blood pressure, leading to heart failure Hypothyroidism = Decreases thyroid hormone, affecting heart function Ischemic cardiomyopathy = Restricts blood flow to the heart, leading to failure Nonischemic cardiomyopathy = Damages the heart muscle, leading to failure Signup and view all the answers

Match the following heart failure classification systems with their corresponding descriptions:

NYHA = Classifies heart failure based on symptoms and physical activity limitations ACC/AHA = Classifies heart failure based on stages of disease progression LVEF = Measures the percentage of blood ejected from the ventricle HFrEF = Classifies heart failure based on reduced ejection fraction Signup and view all the answers

Match the following heart failure management approaches with their corresponding goals:

Control BP and volume overload = Reduce fluid buildup and hypertension Medication adjustment = Optimize medication dosages for heart failure management Lifestyle changes = Improve patient's ability to exercise and manage symptoms Device therapy = Use devices such as ICDs to manage heart failure Signup and view all the answers

Match the following heart failure symptoms with their corresponding descriptions:

Paroxysmal nocturnal dyspnea = Waking up with shortness of breath Tachypnea = Rapid breathing rate Cough = Persistent coughing, possibly due to fluid buildup Fatigue = Lack of energy, leading to exercise intolerance Signup and view all the answers

Match the following heart failure classification systems with their corresponding descriptions:

NYHA = Classifies heart failure based on physical activity limitations ACC/AHA = Classifies heart failure based on disease progression and treatment EF = Measures the percentage of blood pumped out of the heart's ventricles PAD = Classifies heart failure based on peripheral artery disease Signup and view all the answers

Match the following heart failure causes with their corresponding pathophysiologies:

Hypertension = Increases afterload, leading to left ventricular hypertrophy Chronic kidney disease = Impairs kidney function, leading to fluid retention Hypothyroidism = Decreases cardiac contractility, leading to decreased cardiac output Myocardial infarction = Damages heart muscle, leading to systolic dysfunction Signup and view all the answers

Match the following heart failure symptoms with their corresponding clinical presentations:

Fatigue = Marked limitation to physical activity Palpitation = Less than ordinary activity resulting in fatigue Orthopnea = Shortness of breath when lying down Edema = Swelling of the legs and feet due to fluid retention Signup and view all the answers

Match the following heart failure diagnosis and assessment tools with their corresponding purposes:

Ejection fraction = Assesses the percentage of blood pumped out of the heart's ventricles Vital signs = Monitors heart rate and blood pressure Laboratory results = Assesses kidney function and electrolyte levels Thyroid-stimulating hormone = Assesses thyroid function Signup and view all the answers

Match the following heart failure treatments with their corresponding indications:

Enalapril = Treats hypertension and heart failure Metoprolol = Treats heart failure and reduces mortality Furosemide = Treats fluid retention and edema Cilostazol = Treats peripheral artery disease Signup and view all the answers

Match the following heart failure classification systems with their corresponding NYHA classes:

NYHA I = No symptoms with ordinary activity NYHA II = Mild symptoms with ordinary activity NYHA III = Marked symptoms with less than ordinary activity NYHA IV = Severe symptoms at rest Signup and view all the answers

Match the following heart failure pathophysiologies with their corresponding ejection fractions:

Systolic dysfunction = Ejection fraction less than 40% Diastolic dysfunction = Ejection fraction greater than 40% Heart failure with preserved ejection fraction = Ejection fraction greater than 50% Heart failure with reduced ejection fraction = Ejection fraction less than 50% Signup and view all the answers

Match the following heart failure causes with their corresponding prevalence:

Hypertension = Leading cause of heart failure Ischemic cardiomyopathy = One-third of heart failure cases Nonischemic cardiomyopathy = One-third of heart failure cases Chronic kidney disease = Common comorbidity in heart failure patients Signup and view all the answers

Match the following terms with their corresponding descriptions related to Heart Failure:

Ejection Fraction (EF) = a measurement of the percentage of blood leaving the heart each time it contracts Heart Failure with Reduced Ejection Fraction (HFrEF) = a type of heart failure characterized by an EF of 40% or lower Heart Failure with Preserved Ejection Fraction (HFpEF) = a type of heart failure characterized by an EF of 50% or higher Left Ventricular Ejection Fraction (LVEF) = a measurement of the EF only in the left ventricle Signup and view all the answers

Match the following conditions with their effects on the heart, leading to Heart Failure:

Hypertension = increases the demand on the heart Coronary Heart Disease = damages the heart muscle Aortic Stenosis = increases the pressure on the heart Hyperthyroidism = increases the heart rate Signup and view all the answers

Match the following terms with their corresponding definitions related to Heart Failure pathophysiology:

Structural cardiac disorder = a condition that affects the heart's structure Functional cardiac disorder = a condition that affects the heart's function Ventricular dysfunction = a condition where the ventricle cannot fill or eject blood properly Cardiac syndrome = a complex condition characterized by ventricular dysfunction Signup and view all the answers

Match the following symptoms with their corresponding effects on patients with Heart Failure:

Fatigue = reduces exercise tolerance Palpitation = increases heart rate Orthopnea = causes shortness of breath when lying down Dyspnea = causes shortness of breath on exertion Signup and view all the answers

Match the following diagnostic tools with their corresponding uses in Heart Failure diagnosis:

Ejection Fraction (EF) = assesses the heart's pumping ability Left Ventricular Ejection Fraction (LVEF) = assesses the left ventricle's pumping ability Fluid status assessment = evaluates the body's fluid volume Cardiac output formula = calculates the heart's output Signup and view all the answers

Match the following terms with their corresponding characteristics related to Heart Failure:

Heart Failure = a complex clinical syndrome caused by any structural or functional cardiac disorder Heart Failure with Reduced Ejection Fraction (HFrEF) = a type of heart failure characterized by an EF of 40% or lower Heart Failure with Preserved Ejection Fraction (HFpEF) = a type of heart failure characterized by an EF of 50% or higher Congestive Heart Failure = a term that is not preferred because it implies volume overload Signup and view all the answers

Match the following causes with their corresponding effects on the heart, leading to Heart Failure:

Coronary Artery Disease = damages the heart muscle Hypertension = increases the demand on the heart Myocarditis = inflammation of the heart muscle Idiopathic cardiomyopathy = a condition of unknown cause Signup and view all the answers

Match the following terms with their corresponding definitions related to Heart Failure diagnosis:

Ejection Fraction (EF) = a measurement of the heart's pumping ability Left Ventricular Ejection Fraction (LVEF) = a measurement of the left ventricle's pumping ability Heart Failure classification = a system to categorize heart failure severity Fluid status assessment = evaluates the body's fluid volume Signup and view all the answers

Study Notes

HF Case 2: Patient Presentation and Management

62-year-old man with a history of CHD, HTN, depression, CKD, PAD, osteoarthritis, hypothyroidism, and HF (LVEF of 25%).
Medications include aspirin, simvastatin, enalapril, metoprolol, furosemide, cilostazol, acetaminophen, sertraline, and levothyroxine.
Vital signs: BP 120/70 mm Hg, HR 72 beats/minute.
Laboratory results: K 4.1 mEq/L, SCr 2.8 mg/dL, and thyroid-stimulating hormone of 2.6 mIU/L.
HF is stable and considered NYHA class II.

HFrEF Algorithm and Management

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.
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 in patients with HFrEF.
Nondihydropyridine calcium channel blockers (CCBs) with negative inotropic effects can be harmful in patients with low EF and should be avoided.
DHP CCBs have no proven benefit on morbidity or mortality in HF.

Device Therapy

Implantable cardioverter defibrillator recommended for primary prevention of sudden cardiac death in patients with ischemic or nonischemic HFrEF.
Chronic resynchronization therapy recommended for those with an LVEF of 35% or less, in SR, and a left bundle branch block with a QRS of 150 milliseconds or greater.

HFrEF Pathophysiology

CO = HR × SV (cardiac output equals heart rate times stroke volume).
Causes of systolic dysfunction (decreased contractility) include various cardiotoxins.

HFrEF Clinical Presentation

Patient presentation may range from asymptomatic to cardiogenic shock.
Primary symptoms include dyspnea (especially on exertion) and fatigue, leading to exercise intolerance.
Other symptoms include orthopnea, paroxysmal nocturnal dyspnea, tachypnea, cough, fluid overload, pulmonary congestion, and peripheral edema.
Nonspecific symptoms may include fatigue, nocturia, hemoptysis, abdominal pain, anorexia, nausea, bloating, ascites, poor appetite, and weight gain or loss.

HFrEF Diagnosis

Assessment of fluid status and ejection fraction (usually < 50%).

Heart Failure Definition

Heart failure is a complex clinical syndrome caused by any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood.
The term "heart failure" is preferred over "congestive heart failure" because not all patients present with volume overload.