View Full Version : Frequesntly tested CHF management on USMLE STEP 3

08-25-2013, 11:36 PM

Patient presents with fatigue, exertional dyspnea, edema, JVD

Boards favorite scenario - Patient been using two pillows to sleep or sleeps on a chair

New york heart CHF classification
- Class I- No limitation - Class II- Limitations with moderate exercise
- Class III- Limitations with mild activity
- Class IV-Limitations even at rest


➢ Initial test: Echocardiograph
- If ejection fraction < 45%⇒ Dx. Systolic dysfunction
- If ejection fraction > 45% ⇒Dx. Disystolic dysfunction

➢ Accurate test: MUGA scan (nuclear ventriculography)

Frequently tested


➢ For systolic dysfunction:

- ACE-inhibitor or ARBS (lowers mortality)
- Metoprolol (lowers mortality)
- Spironolactone (lowers mortality in type III and type IV CHF)
- Digoxin (reduces the hospitalization)
- Furosemide

If a patient on ACE inhibitor develops angioedema
Tx. hydralazine and isosorbide

➢ For disystolic dysfunction: Tx. metoprolol or carvedilol + diuretics

➢ If QRS> 130 msec -Tx. Biventricular pacemaker

➢ If EF< 35% - Tx. Implantable defibrillator

➢ If EF< 25% - Tx. Angiography

Complication: ( for further details please check the book )

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