NSG 555 QUIZ 2 MODULE 5 CV PART 2 HF, MURMURS,
ENDO/MYOCARDITIS, LIPIDS, METABOLIC SYNDROME AND
ANSWERS WITH COMPLETE SOLUTIONS VERIFIED
HF definition
clinical syndrome defined by: any structural or functional impairment of ventricular filling
or ejection of blood
Stages of heart failure
stage A- cardiac structure abnormalities but no symptoms. goal: reduce risk
stage B-increased filling pressures, persistently elevated troponin without dx or
increased BNP
stage C-Structural heart disease with current or previous symptoms of HF.
stage D- Marked HF symptoms that interfere with daily life and with recurrent
hospitalizations despite attempts to optimize GDMT.
most common causes of HF
ischemic heart disease and myocardial infarction (MI), hypertension, and valvular heart
disease (VHD
approach to HF
clinicians should seek the cause of HF because appropriate treatment may be
determined by the cause
assessing clinical s/s of congestion in HF
,presence of jugular venous distention, orthopnea, bendopnea, a square-wave response
to the Valsalva maneuver, and leg edema
lab studies for heart failure
complete blood count, urinalysis, serum electrolytes (including sodium, potassium,
calcium, and magnesium), blood urea nitrogen, serum creatinine, glucose, fasting lipid
profile, liver function tests, iron studies (serum iron, ferritin, transferrin saturation), and
thyroid-stimulating hormone level and electrocardiography
imaging recommendations for HF
comprehensive TTE is the most useful initial diagnostic test given the vast amount of
diagnostic and prognostic information provided. The determination of LVEF is a
fundamental step to classify HF and to guide evidence-based pharmacological and
device-based therapy
exercise tolerance testing in HF
CPET and the 6-minute walk test are standardized, reliable, and reproducible tests to
quantify functional capacity.19-22 The NYHA functional classification can be used to
grade the severity of functional limitation based on patient report of symptoms
experienced with activity1 and is used to define candidates for certain treatments.
Stage A heart failure management
patients who are at high risk for developing heart failure but have no structural
abnormalities
BP <130/80
diet
, exercise
weight loss
stop smoking
If diabetics SGLT2 (flozin) or GLP-1 (tide)
Stage B heart failure management
pre-HF (increased filling pressures, persistently elevated troponin without dx or
increased BNP)
Start ACEI or ARB if LVEF <40
BB if LVEF <40 and hx CAD or MI (some also say just start these anyway)
ICD if LVEF <30
Statin if indicated
NO CCBs OR TZDs !!!!
Stage C and D management
ACE/ARB
SGLT2 if dbtc or GLP-1
BB
Diuretic if needed (spironolactone)
diuretics in HF
Bumetanide, furosemide, and torsemide inhibit reabsorption of sodium or chloride at the
loop of Henle, whereas thiazide and thiazide-like diuretics act in the distal convoluting
ENDO/MYOCARDITIS, LIPIDS, METABOLIC SYNDROME AND
ANSWERS WITH COMPLETE SOLUTIONS VERIFIED
HF definition
clinical syndrome defined by: any structural or functional impairment of ventricular filling
or ejection of blood
Stages of heart failure
stage A- cardiac structure abnormalities but no symptoms. goal: reduce risk
stage B-increased filling pressures, persistently elevated troponin without dx or
increased BNP
stage C-Structural heart disease with current or previous symptoms of HF.
stage D- Marked HF symptoms that interfere with daily life and with recurrent
hospitalizations despite attempts to optimize GDMT.
most common causes of HF
ischemic heart disease and myocardial infarction (MI), hypertension, and valvular heart
disease (VHD
approach to HF
clinicians should seek the cause of HF because appropriate treatment may be
determined by the cause
assessing clinical s/s of congestion in HF
,presence of jugular venous distention, orthopnea, bendopnea, a square-wave response
to the Valsalva maneuver, and leg edema
lab studies for heart failure
complete blood count, urinalysis, serum electrolytes (including sodium, potassium,
calcium, and magnesium), blood urea nitrogen, serum creatinine, glucose, fasting lipid
profile, liver function tests, iron studies (serum iron, ferritin, transferrin saturation), and
thyroid-stimulating hormone level and electrocardiography
imaging recommendations for HF
comprehensive TTE is the most useful initial diagnostic test given the vast amount of
diagnostic and prognostic information provided. The determination of LVEF is a
fundamental step to classify HF and to guide evidence-based pharmacological and
device-based therapy
exercise tolerance testing in HF
CPET and the 6-minute walk test are standardized, reliable, and reproducible tests to
quantify functional capacity.19-22 The NYHA functional classification can be used to
grade the severity of functional limitation based on patient report of symptoms
experienced with activity1 and is used to define candidates for certain treatments.
Stage A heart failure management
patients who are at high risk for developing heart failure but have no structural
abnormalities
BP <130/80
diet
, exercise
weight loss
stop smoking
If diabetics SGLT2 (flozin) or GLP-1 (tide)
Stage B heart failure management
pre-HF (increased filling pressures, persistently elevated troponin without dx or
increased BNP)
Start ACEI or ARB if LVEF <40
BB if LVEF <40 and hx CAD or MI (some also say just start these anyway)
ICD if LVEF <30
Statin if indicated
NO CCBs OR TZDs !!!!
Stage C and D management
ACE/ARB
SGLT2 if dbtc or GLP-1
BB
Diuretic if needed (spironolactone)
diuretics in HF
Bumetanide, furosemide, and torsemide inhibit reabsorption of sodium or chloride at the
loop of Henle, whereas thiazide and thiazide-like diuretics act in the distal convoluting
