Heart Failure Overview Quiz
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Questions and Answers

What is the hallmark of heart failure?

  • High diastolic pressure
  • Normal ventricular pressure
  • Increased cardiac output
  • Low cardiac output (correct)

    • Which of the following reflects a common symptom of left heart failure?

  • Liver congestion
  • Orthopnea (correct)
  • Increased jugular venous pressure
  • Pitting edema

    • What causes increased pulmonary capillary pressure in left heart failure?

  • Decreased right ventricular pressure
  • Increased left ventricular end-diastolic pressure (LVEDP) (correct)
  • Increased systemic vascular resistance
  • Decreased left atrial pressure

    • Which condition is most commonly associated with right heart failure?

    <p>Chronic obstructive pulmonary disease (COPD)</p> Signup and view all the answers

    What physiologic change occurs when a person with impaired ventricle lies flat?

    <p>Increased venous return to the heart</p> Signup and view all the answers

    Which symptom is typically not associated with left heart failure?

    <p>Lower extremity edema</p> Signup and view all the answers

    What does high pressure in the right atrium indicate?

    <p>Elevated central venous pressure</p> Signup and view all the answers

    What physiological phenomenon leads to dyspnea in patients with left heart failure?

    <p>Decreased left ventricular compliance</p> Signup and view all the answers

    What is a significant reason for the reduction in the use of digoxin for heart failure treatment?

    <p>Digoxin was found to have no mortality benefit.</p> Signup and view all the answers

    What is the primary mechanism by which digoxin increases cardiac contractility?

    <p>Inhibiting the Na-K-ATPase pump.</p> Signup and view all the answers

    Which patient population can benefit from the use of digoxin in heart failure treatment?

    <p>Patients with persistent symptoms despite maximal therapy on other drugs.</p> Signup and view all the answers

    Which of the following statements about digoxin side effects is true?

    <p>Digoxin can lead to significant side effects in some patients.</p> Signup and view all the answers

    What is the main treatment approach for chronic diastolic heart failure based on current guidelines?

    <p>Management of comorbid conditions like hypertension and diabetes.</p> Signup and view all the answers

    What is a classic lung finding in heart failure?

    <p>Rales</p> Signup and view all the answers

    Which hormone counteracts the effects of the renin-angiotensin-aldosterone system (RAAS)?

    <p>Atrial natriuretic peptide (ANP)</p> Signup and view all the answers

    What indicates forward heart failure symptoms?

    <p>Cool extremities and confusion</p> Signup and view all the answers

    What is a common diagnostic tool for assessing heart failure severity?

    <p>Echocardiogram</p> Signup and view all the answers

    What does an increased left ventricular end-diastolic pressure (LVEDP) indicate?

    <p>Left heart congestion/failure</p> Signup and view all the answers

    In systolic heart failure, what happens to stroke volume?

    <p>Decreases due to decreased contractility</p> Signup and view all the answers

    What is a distinguishing factor of diastolic heart failure compared to systolic heart failure?

    <p>Normal ejection fraction</p> Signup and view all the answers

    Which of the following is associated with lower extremity pitting edema in heart failure?

    <p>Increased capillary hydrostatic pressure</p> Signup and view all the answers

    During hepatojugular reflux, what is a normal response of jugular venous pressure (JVP)?

    <p>Sustained rise of over 3 cm with pressure</p> Signup and view all the answers

    What characterizes concentric hypertrophy seen in diastolic heart failure?

    <p>Stiffened ventricle walls</p> Signup and view all the answers

    What typically indicates a failing right ventricle?

    <p>Elevated jugular venous pressure</p> Signup and view all the answers

    What is a significant effect of the activation of the sympathetic nervous system in heart failure?

    <p>Increased vascular resistance</p> Signup and view all the answers

    What is the main role of brain natriuretic peptide (BNP) in heart failure diagnosis?

    <p>Indicates volume overload</p> Signup and view all the answers

    What change occurs in total peripheral resistance with decreasing cardiac output?

    <p>Increases due to vasoconstriction</p> Signup and view all the answers

    What is the primary mechanism of action of ACE inhibitors in heart failure management?

    <p>Block the conversion of AI to AII</p> Signup and view all the answers

    Which of the following drugs is known to have a side effect of dry cough?

    <p>Captopril</p> Signup and view all the answers

    Which common side effect is associated with potassium-sparing diuretics?

    <p>Hyperkalemia</p> Signup and view all the answers

    Which of the following beta blockers is beneficial in treating chronic systolic heart failure?

    <p>Carvedilol</p> Signup and view all the answers

    What is the effect of neprilysin inhibitors like Sacubitril?

    <p>Promote vasodilation and natriuresis</p> Signup and view all the answers

    Which class of medications directly block angiotensin II receptors?

    <p>Angiotensin receptor blockers (ARBs)</p> Signup and view all the answers

    What is the main role of beta blockers in systolic heart failure treatment?

    <p>Reduce mortality and hospitalizations</p> Signup and view all the answers

    Which side effect is specifically noted for spironolactone?

    <p>Gynecomastia</p> Signup and view all the answers

    What is a key effect of using an implantable cardiac defibrillator (ICD)?

    <p>Reduce the risk of sudden cardiac death</p> Signup and view all the answers

    Which medication should not be given together with ACE inhibitors due to the risk of angioedema?

    <p>Neprilysin inhibitors</p> Signup and view all the answers

    What effect does ivabradine have on heart rate?

    <p>Decreases heart rate without affecting contractility</p> Signup and view all the answers

    What condition is NOT typically treated with specific drug therapy as per heart failure guidelines?

    <p>Diastolic heart failure</p> Signup and view all the answers

    Which drug class is associated with the reduction of renal failure in chronic heart failure treatment?

    <p>ACE inhibitors</p> Signup and view all the answers

    What is the defining characteristic of high output heart failure?

    <p>High cardiac output</p> Signup and view all the answers

    Which condition is commonly associated with diastolic heart failure?

    <p>Age</p> Signup and view all the answers

    What is a primary cause of systolic heart failure?

    <p>Myocardial infarction</p> Signup and view all the answers

    What is the classic sign of restrictive heart disease?

    <p>Increased jugular venous pressure</p> Signup and view all the answers

    What process initiates tachycardia-mediated cardiomyopathy?

    <p>Prolonged rapid heart rate</p> Signup and view all the answers

    Which of the following statement is true regarding Fabry disease?

    <p>It is caused by a deficiency of α-galactosidase A</p> Signup and view all the answers

    What is a major cause of restrictive cardiomyopathy linked to granulomas?

    <p>Sarcoidosis</p> Signup and view all the answers

    What type of heart failure is categorized by heart failure with preserved ejection fraction?

    <p>Diastolic heart failure</p> Signup and view all the answers

    Which symptom is most commonly associated with restrictive heart disease?

    <p>Significant dyspnea</p> Signup and view all the answers

    What is the primary consequence of chronic alcohol consumption on the heart?

    <p>Cardiomyopathy</p> Signup and view all the answers

    Which of the following is a potential consequence of tachycardia-mediated cardiomyopathy?

    <p>Reversible heart function improvement</p> Signup and view all the answers

    Which heart failure type shows symptoms despite normal left ventricular function?

    <p>Diastolic heart failure</p> Signup and view all the answers

    Which viral infection commonly leads to myocarditis?

    <p>Coxsackie virus</p> Signup and view all the answers

    What hallmark of restrictive cardiomyopathy is indicated by Kussmaul's sign?

    <p>Elevated JVP during inspiration</p> Signup and view all the answers

    What is the primary function of loop diuretics in treating acute heart failure?

    <p>Inhibit Na-K-Cl pump for salt-water excretion</p> Signup and view all the answers

    Which of the following is a common cause of acute exacerbations of heart failure?

    <p>Dietary indiscretion</p> Signup and view all the answers

    What is the main mechanism of action for nitrates in heart failure therapy?

    <p>Venous dilation to reduce preload</p> Signup and view all the answers

    What notable side effect is associated with the use of furosemide?

    <p>Hypokalemia</p> Signup and view all the answers

    Which inotropic agent is primarily a beta-1 agonist known for increasing heart rate and contractility?

    <p>Dobutamine</p> Signup and view all the answers

    What is a significant risk associated with the routine use of inotropes in heart failure patients?

    <p>Increased mortality</p> Signup and view all the answers

    What should post-discharge follow-up focus on to prevent readmission in heart failure patients?

    <p>Medication adherence</p> Signup and view all the answers

    What is an important effect of metolazone when used in conjunction with loop diuretics?

    <p>Provides a diuretic boost</p> Signup and view all the answers

    What distinguishes acute heart failure therapy from chronic heart failure therapy?

    <p>Focus on symptom relief versus reduction in mortality</p> Signup and view all the answers

    Which class of drugs is primarily used for 'afterload reduction' in heart failure management?

    <p>Vasodilators</p> Signup and view all the answers

    Which of the following best describes the effect of NSAIDs on heart failure?

    <p>Increased salt and water retention</p> Signup and view all the answers

    What common symptom would likely lead to an ER presentation for a patient with acute heart failure?

    <p>Dyspnea</p> Signup and view all the answers

    Which of the following agents is primarily a vasodilator that requires careful monitoring due to its potential for hypotension?

    <p>Nitrates</p> Signup and view all the answers

    In a case of systolic heart failure, what is the expected outcome of using an inotrope?

    <p>Increased heart rate and contractility</p> Signup and view all the answers

    Study Notes

    Heart Failure Basics

    • Heart failure is an impaired ability of the heart to pump blood effectively, resulting in low cardiac output (CO).
    • A visual analogy depicts the heart as a pump, and the body's circulation as the flow of water from a tank.
    • Left ventricular failure leads to increased left ventricular pressure (LV pressure).
    • LVEDP (left ventricular end-diastolic pressure) is always high in left heart failure.
    • A hallmark of left heart failure is less blood pumped out, with more blood left behind in the heart.
    • A stiff ventricle (diastolic HF) leads to high pressure.
    • Increased LVEDP leads to increased left atrial pressure and increased pulmonary capillary pressure.
    • Increased pulmonary capillary pressure leads to dyspnea and pulmonary edema.
    • Increased right heart pressures lead to high pressure in the venous system.
    • High jugular venous pressure (neck veins) is a sign.
    • Capillary leakage leads to pitting edema.

    Heart Failure Pathophysiology

    • Failing chambers lead to increased pressures in the cardiac chambers.
    • Left ventricular failure leads to increased LV pressure.
    • LV systolic pressure depends on contractility (can be low).
    • LVEDP is always high in left heart failure.
    • Less blood pumped out, more left behind.
    • Stiff ventricle (diastolic HF)→high pressure.

    Heart Failure Pathophysiology: Pulmonary Systems

    • Increased LVEDP → increased LA pressure.
    • Increased LA pressure → increased pulmonary capillary pressure.
    • Increased pulmonary capillary pressure leads to dyspnea and pulmonary edema.
    • Increased pressure in the pulmonary artery (PA) leads to increased right ventricular (RV) pressure.
    • Increased RV pressure → increased right atrial (RA) pressure.
    • Right atrial pressure is equal to central venous pressure.

    Heart Failure Signs/Symptoms

    • Physiological effects of lying flat (supine): Increased venous return, redistribution of blood volume from extremities and splanchnic beds to the lungs, and worsened pulmonary congestion and breathing.
    • Left heart failure: Dyspnea especially on exertion. Paroxysmal nocturnal dyspnea (wake up SOB), Orthopnea (can't breathe lying flat).
    • Right heart failure: Increased jugular venous pressure. Lower extremity edema, Liver congestion (rarely can cause cirrhosis), "Backward failure"

    Heart Failure Right Heart Failure

    • The most common cause of right-heart failure is left heart failure.
    • Right heart failure can occasionally occur in isolation (not related to left heart failure).
    • High pressure in the pulmonary artery, right ventricle, and right atrium usually occur secondary to a lung process.
    • Pulmonary hypertension and COPD often lead to this type of failure.

    Heart Failure Signs/Symptoms: Low Flow

    • Low flow signs/symptoms ("forward failure"): Loss of appetite, weight loss (cachexia), confusion (mental status changes), cool extremities, and narrow pulse pressure.
    • Narrow pulse pressure is only seen in systolic heart failure

    Heart Failure Lung Findings

    • Classic finding in heart failure is rales (crackles).
    • Fluid-filled alveoli "pop" open with inspiration.
    • Chest X-ray shows congestion, although this may not be apparent in chronic heart failure.

    Heart Failure Lung Findings (Cellular Level)

    • Heart failure cells, hemosiderin (iron) laden macrophages, and brown pigment are found in macrophages (specialized immune cells).

    Heart Failure Signs/Symptoms (Jugular Venous Pressure)

    • Elevated jugular venous pressure (normal 6-8 cm H2O) is a key symptom.
    • Look for height of double bounce (caused by a and v waves).

    Heart Failure Hepatojugular Reflux

    • Pressure on the abdomen raises JVP 1-3 cm normally.
    • The increase is greater in people with failing right ventricle(RV).

    Heart Failure Signs/Symptoms (Edema)

    • Lower extremity pitting edema.
    • Increased capillary hydrostatic pressure.
    • Fluid leak from capillaries to tissues

    Heart Failure Abnormal Heart Sounds

    • S3 (associated with high left atrial pressure).
    • S4 (associated with stiff left ventricle).
    • Displaced apical impulse indicates an enlarged heart.

    Heart Failure Pathophysiology (Systemic Response)

    -All forms of heart failure cause a decrease in cardiac output.

    • Activation of the sympathetic nervous system results.
    • Activation of the renin-angiotensin-aldosterone system occurs.
    • Both systems work together to lead to increased peripheral vascular resistance and sodium and water retention.

    Heart Failure Total Peripheral Resistance

    • Cardiac output decreases, leading to vasoconstriction.
    • Angiotensin II and the sympathetic nervous system cause this to happen, leading to a higher total peripheral resistance (TPR).
    • . Blood pressure is often high but can be low.

    Heart Failure Sodium/Water Retention

    • Decreased cardiac output → decreased effective circulating blood volume.
    • This stimulates the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS), triggering anti-diuretic hormone (ADH) release to increase sodium/water retention.

    Heart Failure Other Hormones (ANP)

    • Atrial natriuretic peptide (ANP) is released in response to atrial stretch.
    • ANP is a vasodilator and promotes increased diuresis, which counteracts the effects of the RAAS system.

    Heart Failure Other Hormones (BNP)

    • Brain natriuretic peptide (BNP) is released by ventricles from volume and pressure overload.
    • BNP helps to counteract RAAS and provide a diagnosis for heart failure. High levels suggest heart failure, while low levels suggest something else.

    Nesiritide

    • Recombinant BNP.
    • Causes vasodilation.
    • Lowers afterload and increases CO.
    • Failed to improve efficacy in clinical trials

    Heart Failure Diagnosis

    • Most commonly, diagnosis is based on typical signs, symptoms and elevated BNP level.
    • Heart catheterization is used for specific diagnostic measurement.
    • Increased LVEDP suggests left heart congestion/failure.
    • Increased RA/RVEDP suggest right heart congestion/failure

    Systolic and Diastolic Heart Failure

    • Ejection fraction is reduced (systolic).
    • Ejection fraction is normal (55-65%) (diastolic).

    Systolic vs. Diastolic Heart Failure (Signs and Symptoms)

    • Both have similar congestive signs and symptoms (dyspnea, orthopnea, paroxysmal nocturnal dyspnea, rales, ↑ JVP, pitting edema)
    • The exception is systolic heart failure exhibits low flow symptoms, including cool extremities, cachexia and confusion.

    Dilated Cardiomyopathy

    • Systolic heart failure with LV cavity dilation.
    • Volume overload (chronic retention of fluid in cavity)
    • Increased myocyte size and sarcomere lengths in series.
    • Normal wall thickness.

    Concentric Hypertrophy

    • Pressure overload in the ventricle.
    • Chronic hypertension, or aortic stenosis
    • Causes a decrease in compliance (stiff ventricle).
    • Increased myocyte size and sarcomere increase in parallel resulting in thickness of walls

    Systolic Heart Failure (Problem/Mechanism)

    • Problem is in systole (contraction) - The heart cannot effectively pump blood out.
    • Ejection fraction is low
    • Stroke volume is decreased.
    • Increased end-systolic volume.
    • End-diastolic volume is increased.
    • Left ventricular end-diastolic pressure (LVEDP) is increased.

    Diastolic Heart Failure (Problem/Mechanism)

    • Problem is in diastole (filling).
    • The heart cannot effectively fill with blood
    • EDV is decreased.
    • LVEDP is elevated (due to ventricular stiffness).

    Systolic vs. Diastolic Heart Failure (Values)

    • The table shows normal, systolic/dilated, and diastolic values for EDV, ESV, SV/CO, and EF%.

    Systolic Heart Failure (Causes)

    • Myocardial infarction (MI) is the most common cause.
    • Ischemic cardiomyopathy and many non-ischemic cardiomyopathies are also causes.

    Diastolic Heart Failure (Causes)

    • The exact cause is unknown, however, concentric hypertrophy, age, diabetes & hypertension are common associated conditions.

    Nonischemic Cardiomyopathy (Viral)

    • May follow an upper respiratory infection, and often associated with viruses (including Coxsackie).
    • Virus enters myocytes and causes myocarditis that can progress to cardiomyopathy.
    • Myocarditis phase is often missed/undiagnosed.

    Nonischemic Cardiomyopathy (Peri-partum)

    • Late in pregnancy and early post-pregnancy.
    • Exact cause is unknown, but likely multifactorial.

    Nonischemic Cardiomyopathy (Chemotherapy)

    • Usually comes from anthracycline chemotherapy.
    • Antitumor antibiotics Doxorubicin and Daunorubicin can cause it.

    Nonischemic Cardiomyopathy (Familial)

    • Mutations in sarcomere proteins (including Beta and Alpha myosin heavy chain, and Troponin)
    • Many are autosomal dominant, some are x-linked or autosomal recessive.

    Nonischemic Cardiomyopathy (Tachycardia-mediated)

    • Constant, rapid heart rate for weeks or months.
    • Causes a decrease in LV systolic function.
    • Usually reversible with slowing the heart rate

    Nonischemic Cardiomyopathy (Takotsubo/Apical Ballooning)

    • Stress-induced cardiomyopathy occurs after sever emotional distress.
    • Leads to a markedly reduced left ventricular ejection fraction (LVEF).
    • It presents as increased CK, MB, Troponin, and EKG changes.
    • Looks like anterior myocardial infarction (MI), but no coronary disease.

    Nonischemic Cardiomyopathy (Alcohol)

    • Chronic alcohol consumption can cause cardiomyopathy.
    • It's thought to be due to toxic metabolites.
    • It can sometimes reverse with cessation.

    High Output Heart Failure

    • Heart is in overdrive.
    • Causes include severe anemia, thyroid disease, thiamine deficiency (beriberi), and arteriovenous (AV) Fistulas.
    • Exact mechanism is unclear.
    • Defining characteristic is a high cardiac output.
    • It can present as high JVP, and pulmonary edema.

    Restrictive Cardiomyopathy

    • Something infiltrates the myocardium.
    • Granulomas (sarcoid) and amyloid protein (amyloidosis) are infiltrators.
    • Heart cannot relax and fill effectively.
    • Severe diastolic dysfunction, with LVEF being normal.

    Restrictive Heart Disease (Clinical Features)

    • Dyspnea (shortness of breath).
    • Prominent right heart failure signs (elevated jugular venous pressure (JVP), lower extremity edema, liver congestion; possibly leading to cirrhosis).

    Restrictive Heart Disease (Classic Signs)

    • Kussmaul's sign: Inspiration causes a rise in jugular venous pressure (JVP).

    Restrictive Heart Disease (Rhythm Disturbances)

    • Myocardial infiltration can disrupt electrical activity.
    • Arrhythmias (including sudden death risk).
    • Atrioventricular (AV) block.

    Restrictive Heart Disease (Major Causes: Amyloidosis)

    • Amyloid protein deposits in the heart.
    • Various forms of amyloidosis include primary, and secondary.

    Restrictive Heart Disease (Classic Signs: EKG)

    • Thickened myocardium can be visualized.
    • Low-voltage on EKG may appear in cases of amyloidosis and Fabry's disease.

    Restrictive Heart Disease (Major Causes: Sarcoidosis)

    • Granuloma formation often observed in the lungs, but can affect other extra-pulmonary organs, including the heart.

    Restrictive Heart Disease (Major Causes: Fabry Disease)

    • Lysosomal storage disease with deficiency of alpha-galatosidase A leads to ceramide trihexoside accumulation.

    Restrictive Heart Disease (Major Causes: Hemochromatosis)

    • Iron excess commonly causing dilated cardiomyopathy.
    • Can rarely lead to restrictive cardiomyopathy.

    Restrictive Heart Disease (Major Causes: Post-Radiation)

    • Acute inflammation/Fibroblast recruitment may occur from radiation.
    • Accumulation of collagen and fibronectin may occur.

    Restrictive Heart Disease (Major Causes: Other Causes)

    • Pericarditis, pericardial disease, coronary artery disease, valvular disease, conduction abnormalities, or restrictive cardiomyopathy can all cause long-term effects.

    Restrictive Heart Disease (Major Causes: Eosinophilic Infiltrations)

    • Eosinophils may infiltrate myocardium, often with acute episodes/myocarditis (often asymptomatic.)
    • Chronic phase often consists of endomyocardial fibrosis and myocyte death.
    • Thrombus formation is common (embolic stroke risk).

    Restrictive Heart Disease (Major Causes: Endocardial Fibroelastosis)

    • Endocardial thickening (innermost myocardium) is seen in infants during their first year.
    • Proliferation of fibrous (collagen) and elastic fibers.

    Acute Heart Failure

    • Congestion / Swollen
    • Pulmonary Edema
    • Pitting Edema
    • Increased Jugular Vein Pressure (JVP)

    Acute Heart Failure (Causes of Exacerbation)

    • Dietary indiscretion and high salt intake.
    • Poor medication compliance.
    • Infection, trauma or surgery.

    Acute Heart Failure Treatment

    • Primarily focus on symptom relief in hospitalized setting.
    • Contrast with chronic treatment focus on lowering mortality/hospitalizations and preventing further progression.
    • Treat with same type of therapies whether diastolic or systolic based HF.

    Loop Diuretics

    • Inhibit Na-K-Cl pump in the ascending loop of Henle.
    • Increase salt and water excretion, which eases congestion.
    • IV form is better in cases of GI distress.
    • Common side effects include hypokalemia and volume depletion.

    Thiazide-like Diuretic (Metolazone)

    • Thiazide-like diuretic.
    • Inhibits Na/Cl reabsorption in the distal tubule.
    • A "kick" for loop diuretics to increase diuresis.
    • Other side effects include additional fluid and K+ loss.

    Nitrates

    • Predominant mechanism is venous dilation.
    • Expanding veins hold more blood in a way that shifts blood away from the left ventricle.
    • Leads to lower LVEDV (preload) and LA pressure.
    • Reduces pulmonary edema and improves dyspnea (difficulty breathing).

    Nitrates (Side Effects)

    • Side effects include headache (from increased blood vessel dilation), flushing, and hypotension.

    Vasodilators

    • Generally aim to reduce afterload and improve cardiac output.
    • ACE inhibitors and hydralazine classically used.

    Nitrates plus Hydralazine

    • Combination therapy used in acute and chronic HF.
    • The combination therapy reduces preload (nitrates) and afterload (hydralazine).
    • Improves symptoms in acute cases and improves mortality in others.

    Inotropes

    • Increase contractility, but only used in systolic heart failure.
    • Inotropes will NOT work for diastolic HF when contractility is normal.
    • Inotropes work by activating beta-1 pathways.
    • Some increase heart rate and contractility in smooth muscle.
    • May cause vasodilation leading to hypotension

    Inotropes (Milrinone)

    • Phosphodiesterase 3 inhibitor.
    • Breaks down cAMP.
    • Inhibits PD3, which increases cAMP, and contributes to increased inotropy and vasodilation.
    • Side effect: hypotension.

    Inotropes (Dobutamine)

    • Mostly beta-1 agonist.
    • Increases heart rate and contractility.
    • Weak beta-2 agonist means vasodilation.
    • Side effect: hypotension.

    Inotropes (Dopamine)

    • Does not cross the blood-brain barrier, so few CNS side effects.
    • Low dose is a dopamine agonist, leading to some vasodilation in kidneys.
    • Medium dose is a beta-1 agonist, increasing heart rate and contractility.
    • High dose is an alpha agonist causing vasoconstriction.

    Inotropes (Epinephrine)

    • Also dose-dependent effects.
    • Low dose is both beta-1 and beta-2 agonist, increasing heart rate, contractility and vasodilation.
    • High dose is an alpha agonist, increasing vasoconstriction.

    Inotrope Risks

    • Inotrope use may increase mortality.
    • Inotropes are used in very sick patients and closely monitored.

    Typical Acute Heart Failure Course

    • ER presentation (initiation of heart failure symptoms).
    • Hospitalized with symptom management (including symptom relief with Lasix, nitroglycerine, and/or inotropes
    • Symptoms improving → transition to oral medication

    More Complex Acute Heart Failure Course

    • ER presentation (with known LVEF and other presenting complications).
    • Hospitalization, symptom management and improving symptoms.

    Heart Failure Readmission

    • Recurrence is common following discharge from medical care due to heart failure.
    • Post-discharge follow-up is important and critical.

    Chronic Heart Failure

    • Most patients need chronic therapy with diuretics (such as oral furosemide).
    • Some need long acting nitrates, in addition to the diuretics.
    • The choice of therapies depends on whether it is systolic or diastolic dysfunction.

    Chronic Systolic Heart Failure Therapies

    • ACE inhibitors or ARBs, beta-blockers, aldosterone antagonists, neprilysin inhibitors, and ivabradine are effective therapies.

    Implantable Cardioverter-Defibrillator (ICD)

    • Used to reduce annual SCD Risk, often due to ventricular tachycardia.

    Biventricular Pacemakers

    • Cardiac Resynchronization Therapy (CRT) is used to improve heart function and coordination, often with better response/results after CRT

    Chronic Heart Failure Treatment Pathway

    • Acute heart failure receives RX for symptom management.
    • For chronic heart failure, appropriate treatment pathways for diastolic and systolic failure exist.

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