ABIM Advanced HF flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

HFrEF definition

Heart failure with reduced ejection fraction requires symptoms or signs of heart failure and a left ventricular ejection fraction of 40 percent or less.

HFpEF diagnosis

Heart failure with preserved ejection fraction requires signs or symptoms, left ventricular ejection fraction of 50 percent or higher, and objective evidence of elevated filling pressures or structural heart disease.

Fick cardiac output

Cardiac output equals oxygen consumption divided by the arteriovenous oxygen content difference; cardiac index is cardiac output divided by body surface area.

Acute HF natriuretic thresholds

In acute dyspnea, a BNP below 100 pg/mL or NT-proBNP below 300 pg/mL makes acute heart failure unlikely; higher values support diagnosis but require clinical interpretation.

Loop diuretic resistance

Escalate loop diuretic dose to two to two and a half times the home oral dose intravenously, monitor urine output, electrolytes, and renal function, and add a thiazide or acetazolamide for persistent congestion.

Iron deficiency in HF

Iron deficiency in heart failure is ferritin below 100 ng/mL or ferritin 100 to 299 ng/mL with transferrin saturation below 20 percent; intravenous iron may improve symptoms.

Cardiogenic shock criteria

Cardiogenic shock includes hypotension, hypoperfusion, cardiac index below 2.2 L/min/m2, and elevated filling pressures; SCAI stages range from at-risk to extremis.

HFrEF four pillars

Four guideline-directed drug classes for HFrEF are renin-angiotensin system inhibition, evidence-based beta blockade, mineralocorticoid receptor antagonism, and SGLT2 inhibition; each reduces mortality.

INTERMACS profile 1

INTERMACS profile 1 describes critical cardiogenic shock with life-threatening hypotension despite escalating support, often requiring continuous inotropes, vasopressors, or temporary mechanical circulatory support.

LVAD destination therapy

Destination therapy is durable mechanical circulatory support for patients with advanced heart failure who are not transplant candidates, intended to improve survival and quality of life.

HeartMate 3 anticoagulation

The HeartMate 3 centrifugal pump requires warfarin anticoagulation and aspirin; target international normalized ratio is commonly 2.0 to 3.0, with adjustments for bleeding and thrombosis risk.

LVAD GI bleeding

Continuous-flow left ventricular assist devices cause acquired von Willebrand syndrome, increasing gastrointestinal angiodysplasia bleeding; management includes reducing anticoagulation and octreotide or endoscopic therapy.

Post-LVAD right heart failure

Right ventricular failure after left ventricular assist device implantation causes low cardiac output, high central venous pressure, hepatic congestion, and oliguria; treatment includes inotropes, pulmonary vasodilators, and cautious pump speed reduction.

VA-ECMO afterload

Venoarterial extracorporeal membrane oxygenation increases left ventricular afterload; a failing ventricle may need venting with an intra-aortic balloon pump, Impella, or atrial septostomy.

LVAD speed optimization

Left ventricular assist device speed is adjusted to maintain adequate left ventricular unloading, near-midline septum, minimal aortic regurgitation, and sufficient end-organ perfusion without suction events.

Temporary MCS in shock

Temporary mechanical circulatory support options include intra-aortic balloon pump, Impella, TandemHeart, and extracorporeal membrane oxygenation; selection depends on shock severity, right ventricular function, and oxygenation.

Heart transplant indication

Cardiac transplantation is considered for end-stage heart failure despite optimal medical therapy, often with peak oxygen consumption below 14 mL/kg/min, inotrope dependence, or recurrent hospitalizations.

Fixed pulmonary vascular resistance

A pulmonary vascular resistance above 5 Wood units that remains elevated after vasodilator testing increases right heart failure risk after transplantation and is a relative contraindication.

Acute cellular rejection grades

ISHLT acute cellular rejection grades are 0, 1R, 2R, and 3R; grade 2R or 3R generally prompts intensified immunosuppression, while 1R often requires monitoring rather than treatment.

Antibody-mediated rejection

Antibody-mediated rejection shows capillary injury, complement deposition such as C4d, and donor-specific antibodies; treatment includes plasmapheresis, intravenous immunoglobulin, and rituximab.

Cardiac allograft vasculopathy

Cardiac allograft vasculopathy is diffuse intimal hyperplasia in transplanted coronary arteries, driven by immune and nonimmune injury; surveillance uses angiography or intravascular ultrasound, and statins or mTOR inhibitors may slow progression.

CMV prophylaxis

Cytomegalovirus prophylaxis after heart transplantation is guided by donor and recipient serostatus; valganciclovir is common for high-risk mismatches, while lower-risk patients may receive preemptive monitoring.

Pneumocystis prophylaxis

Trimethoprim-sulfamethoxazole is first-line prophylaxis against Pneumocystis jirovecii pneumonia after heart transplantation, typically continued for at least six to twelve months.

Denervated heart response

The transplanted heart is denervated, so resting tachycardia is common and atropine is ineffective; blood pressure and heart rate responses depend on circulating catecholamines and preload.

Pulmonary hypertension definition

Pulmonary hypertension is mean pulmonary artery pressure above 20 mmHg at rest; precapillary disease has pulmonary artery wedge pressure 15 mmHg or less and pulmonary vascular resistance above 2 Wood units.

PVR formula

Pulmonary vascular resistance equals mean pulmonary artery pressure minus pulmonary artery wedge pressure, divided by cardiac output; it is expressed in Wood units.

PAH vasoreactivity testing

Vasoreactivity testing in idiopathic pulmonary arterial hypertension uses inhaled nitric oxide or epoprostenol; a positive response is a fall in mean pulmonary artery pressure of at least 10 mmHg to 40 mmHg or less.

CTEPH diagnosis

Chronic thromboembolic pulmonary hypertension is screened with ventilation-perfusion lung scanning; confirmation uses computed tomographic pulmonary angiography and right heart catheterization.

CTEPH treatment

Pulmonary endarterectomy is potentially curative for chronic thromboembolic pulmonary hypertension; riociguat and balloon pulmonary angioplasty are options for inoperable or persistent disease.

Right heart failure signs

Right heart failure produces elevated jugular venous pressure, hepatomegaly, ascites, peripheral edema, and low cardiac output; management focuses on decongestion and preserving right ventricular perfusion.

Group 2 PH management

Group 2 pulmonary hypertension is due to left heart disease; treatment targets the underlying cardiomyopathy and congestion, and pulmonary arterial hypertension-specific drugs are not routinely recommended.

Acute RV failure support

Acute right ventricular failure management includes cautious fluid or diuretic titration, norepinephrine to maintain systemic pressure, inotropes, oxygen, and avoidance of hypoxia, hypercapnia, and excessive positive pressure.