Pathophys
Left-sided HF leads to pulmonary congestion, while right HF causes a key finding on physical exam. What is the cutt off for this to be positive?
> 8 cmh2o
Kerley B lines
This drug class is now recommended across the entire LVEF spectrum in HF.
SGLT2 inhibitors
Mechanism of action of hydralazine
Increase the release of cGMP → relaxation of smooth muscle → vasodilation → ↓ afterload
This loop diuretic has an IV:PO of 1:2 with a ~320 mg IV max daily dose.
Furosemide
Highly specific auscultatory finding for AHF, heard with the bell at the apex in left lateral decubitus?
S3
Name 3 medication groups that can precipitate a HF exacerbation
NSAIDs, CCB, steroids, anthacyclines, thiazolidinediones, antifungals and antimalarials
Indications for IV iron in HF include a ferritin less than ...
< 100
OR
< 300 with TSat < 20%
When to hold MRA in patient with HFrEF based on CrCl?
Adding this carbonic anhydrase inhibitor to loop diuretics yielded more successful early decongestion in ADVOR.
Acetazoloamide
Name 4 causes of high output HF
Severe anemia, morbid obesity, wet Beri Beri, Paget disease of bone, AV fistula, hyperthyroidism, advanced cirrhosis...
This speckle-tracking measure has higher prognostic value than LVEF (especially when LVEF >45%).
What is global longitudinal strain (GLS)?
If a patient with decompensated HF does not respond to the initial IV diuretic, the dose should be increased by how much? (%)
50-100%
Tafamidis is recommended in patients with NYHA I–II symptoms, from this etiology...
ATTR-CM (Class I/II)
Urine Na+ indicative of good diuretic response in 1-2 hours
> 50-70 mEq/L
This range defines HFmrEF, a spectrum group with prognosis/treatment between HFrEF and HFpEF.
41-49%
Cut -off of NT-proBNP that makes ADHF unlikely with a NPV ~98%.
< 300
In HFpEF with obesity, this GLP-1 RA improved symptoms and exercise function vs placebo.
Semaglutide
What should always be ruled out in de novo HF?
Ischemia
Patient taking furosemide 20 mg PO daily. Comes with acute on chronic HFrEF. We are admitting, what is the recommended dose?
2-2.5x home dose
(Lasix 20-40 mg IV)
Name of the score used to estimate probability of underlying heart failure in patients with preserved ejection fraction on echo.
H2FPEF Score
Mention 7 orders that need to be placed in a patient with decompensated HF.
ECG and trops
NT-proBNP
Lactate
Iron studies
CBC
BMP, Mg
Daily weight, fluid restriction, I/O's
Cardiac telemetry
In HFrEF with recent worsening HF despite maximally tolerated GDMT, this soluble guanylate cyclase stimulator is recommended to reduce CV death/HFH.
Vericiguat
In Black patients with NYHA class III-IV symptoms, what medication can be used in combination with GDMT to reduce mortality compared with placebo.
Name the patient-reported outcome tool that the update emphasizes standardizing in practice.
Kansas City Cardiomyopathy Questionnaire (KCCQ)