Learning Objectives By Lesson1-Heart Failure: Definitions & Evaluation
- Define heart failure
- Describe the signs and symptoms of heart failure
- Describe the stages of heart failure and the goals of management for each stage
- Describe how heart failure can be classfied based on left ventricular ejection fracton
- Identify objective measures and predictive risk scores for diagnosing heart failure with preserved ejection fraction (HFpEF)
- Identify various causes of heart failure
- Describe the importance and approach for obtaining a family history in heart failure assessment
- Describe the diagnostic testing for heart failure evaluation
2-Symptomatic LV Dysfunction (HFmrEF & HFpEF)
- Define heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF)
- Identify objective measures and predictive risk scores used to differentiate cardiac and non-cardiac causes of dyspnea
- Describe the management strategy for patients with heart failure with mildly reduced ejection fraction (HFmrEF)
- Identify contributing risk factors to heart failure with preserved ejection fraction (HFpEF)
- Describe the management strategy for patients with heart failure with preserved ejection fraction (HFpEF)
3-Symptomatic LV Dysfunction (HFrEF)
- Review the stages of heart failure
- Define heart failure with reduced ejection fraction (HFrEF)
- Describe the general management strategies -- both pharmacologic and non-pharmacologic -- for heart failure with reduced ejection fraction (HFrEF)
- Identify the benefits of a multidisciplinary team for heart failure with reduced ejection fraction (HFrEF)
- Describe components of cardiac rehabilitation for heart failure with reduced ejection fraction (HFrEF)
- Describe the physiologic and lifestyle benefits of physical activity for heart failure with reduced ejection fraction (HFrEF)
- Identify potential reasons for a decreased in response to diuretic therapy
- Identify medications with improved clinical outcomes in heart failure with reduced ejection fraction (HFrEF)
- Describe the mechanism of action and potential adverse effects of angiotensin receptor-neprilysin inhibitor (ARNi) medications
- Describe how to transition a patient from an angiotensin converting enzyme inhibitor (ACEi) to an angiotensin receptor-neprilysin inhibitor (ARNi)
- List three beta-blockers associated with improved clinical outcomes
- Describe the role of sodium glucose cotransporter-2 inhibitor (SGLT2i) medications in the management of heart failure with reduced ejection fraction (HFrEF)
- Identify potential adverse effects of sodium glucose cotransporter-2 inhibitor (SGLT2i) medications
- Describe the role for hydralazine and isosorbide dinitrate in the management of heart failure with reduced ejection fraction (HFrEF)
- Describe the role of and rationale for ivabradine in the management of heart failure with reduced ejection fraction (HFrEF)
- Describe the role of digoxin and soluble guanylyl cyclase stimulators in the management of heart failure with reduced ejection fraction (HFrEF)
- Describe the role of device therapy in the management of heart failure with reduced ejection fraction (HFrEF)
- Describe the role, rationale, and indications for cardiac resynchronization therapy (CRT) in the management of heart failure with reduced ejection fraction (HFrEF)
4-Advanced Heart Failure
- Review the stages of heart failure
- Define stage D heart failure
- Describe the four criteria used to diagnose stage D heart failure
- Describe how to identify patients at risk of stage D heart failure
- Describe how the Interagency Registry for Mechanical Assisted Circulatory Support (INTERMACS) classification system can be used to stratify patients with advanced heart failure undergoing consideration of mechanical circulatory support
- Describe the management goals of advanced heart failure
- Identify the advanced therapy options and clinical benefits in advanced heart failure management
- Identify poor outcome predictors of mechanical circulatory support
- Describe the goals of temporary mechanical circulatory support
- Describe the overarching goals of cardiac transplantation
- Identify patient selection considerations in the evaluation of cardiac transplantation candidacy
5-Acute Decompensated Heart Failure
- Identify the immediate goals in the evaluation of a patient with acute decompensated heart failure
- Identify factors that might influence the plan of care in patients presenting with acute decompensated heart failure
- Describe the goal direct medical therapy (GDMT) considerations in patients presenting with acute decompensated heart failure
- Describe the effects of withdrawing goal directed medical therapy (GDMT) following an acute decompensated heart failure hospitalization
- Describe the strategy for intravenous diuresis in the setting of acute decompensated heart failure
- Describe the goal at discharge for an acute decompensated heart failure hospitalization
- Describe how to monitor the efficacy diuresis in the context of an acute decompensated heart failure hospitalization
- Describe decongestion options for acute decompensated heart failure if a patient is refractory to conventional diuresis therapies
- Describe how to optimize perfusion in acute decompensated heart failure hospitalization associated with a low cardiac output state (cardiogenic shock)
- Identify clinical signs of hypoperfusion in cardiogenic shock
- Identify etiologies that might contribute to cardiology shock
- Describe a general approach to optimize perfusion in a low cardiac output state (cardiogenic shock)
- Describe important members of the shock team and the clinical benefit of this team
- Describe the goals in the empiric treatment of cardiogenic shock
6-Hypertrophic Cardiomyopathy: Background & Pathophysiology
- Define hypertrophic cardiomyopathy (HCM)
- Describe the natural history of hypertrophic cardiomyopathy (HCM)
- Describe the inheritance pattern and penetrance of hypertrophic cardiomyopathy (HCM)
- Identify genes associated with hypertrophic cardiomyopathy (HCM)
- Describe the screening and surveillance approaches for patients with hypertrophic cardiomyopathy (HCM) and their family members
- Describe the goals of imaging in hypertrophic cardiomyopathy (HCM)
- Describe potential interventions for hypertrophic cardiomyopathy (HCM)
- Describe the pathophysiology of hypertrophic cardiomyopathy (HCM)
- Describe how left venticular outflow tract obstruction can occur in hypertrophic cardiomyopathy (HCM)
- Identify the gradient and gradient values used to make treatment decisions in hypertrophic cardiomyopathy (HCM)
- Describe the conseuqences of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy (HCM)
- Identify factors that can exacerbate left ventricular outlfow tract obstruction in hypertrophic cardiomyopathy (HCM)
- Describe the management approach to reduce left ventricular outlfow tract obstruction in hypertrophic cardiomyopathy (HCM)
- Describe diastolic dysfunction and its consequences in hypertrophic cardiomyopathy (HCM)
- Describe how myocardial ischemia might be provoked in hypertrophic cardiomyopathy (HCM)
7-Hypertrophic Cardiomyopathy: Management
- Describe the goals of management for patients with hypertrophic cardiomyopathy (HCM)
- Describe the treatment approach for hypertrophic cardiomyopathy (HCM)
- Identify candidates with hypertrophic cardiomyopathy (HCM) who would benefit from septal reduction therapy
- Describe potential complications of surgical myectomy for hypertrophic cardiomyopathy (HCM)
- Describe the basis for hemodynamic and symptomatic success of alcohol septal ablation for hypertrophic cardiomyopathy (HCM)
- Describe potential complications of alcohol septal ablation for hypertrophic cardiomyopathy (HCM)
- Describe the role of pacing in the management of hypertrophic cardiomyopathy (HCM)
- Describe the management approach for patients with for hypertrophic cardiomyopathy (HCM) and the following conditions/setting: reduced left ventricular ejection fraction, atrial fibrillation, sleep disordered breathing, and/or pregnancy
- Identify risk factors associated with sudden cardiac death in the context of hypertrophic cardiomyopathy (HCM)
- Describe a sudden cardiac death risk assessment for hypertrophic cardiomyopathy (HCM)
- Identify candidates with hypertrophic cardiomyopathy (HCM) who would benefit from an automatic implantable cardioverter defibrillator (AICD) for sudden cardiac death prevention
8-Stress Cardiomyopathy (Takotsubo Syndrome)
- Define key characteristics of Takotsubo syndrome (stress cardiomyopathy)
- Describe the morbidity and mortality associated with stress cardiomyopathy (Takotsubo syndrome)
- Describe when stress cardiomyopathy (Takotsubo syndrome) should be suspected
- Identify risk factors and triggers associated with stress cardiomyopathy (Takotsubo syndrome)
- Describe anatomical variants of stress cardiomyopathy (Takotsubo syndrome)
- Describe the pathophysiological hypotheses associated with stress cardiomyopathy (Takotsubo syndrome)
- Describe the clinical presentation of stress cardiomyopathy (Takotsubo syndrome)
- Describe the clinical evaluation of stress cardiomyopathy (Takotsubo syndrome)
- Describe factors that influence the clinical outcomes of patients with stress cardiomyopathy (Takotsubo syndrome)
- Describe the management strategy for stress cardiomyopathy (Takotsubo syndrome)
- Describe the prognosis for patients with stress cardiomyopathy (Takotsubo syndrome)
9-Noncompaction Cardiomyopathy: Definitions & Pathophysiology
- Define left ventricular noncompaction (LVNC) cardiomyopathy
- Idenitfy complications associated with left ventricular noncompaction (LVNC) cardiomyopathy
- Describe various means to classify left ventricular noncompaction (LVNC) cardiomyopathy
- Describe the pathogenesis of hereditary left ventricular noncompaction (LVNC) cardiomyopathy
- Idenitfy genetic mutations attributed to left ventricular noncompaction (LVNC) cardiomyopathy
- Describe theories for pathogenesis of acquired left ventricular noncompaction (LVNC) cardiomyopathy
- Describe the role of genetic testing for left ventricular noncompaction (LVNC) cardiomyopathy
- Describe the association of left ventricular noncompaction (LVNC) cardiomyopathy with other congential heart defects
10-Noncompaction Cardiomyopathy: Evaluation & Management
- Describe the clinical manifestations of left ventricular noncompaction (LVNC) cardiomyopathy
- Describe the ventricular dysfunction that can develop with underlying left ventricular noncompaction (LVNC) cardiomyopathy
- Identify electrical abnormalities associated with left ventricular noncompaction (LVNC) cardiomyopathy
- Identify predictors of mortality associated with left ventricular noncompaction (LVNC) cardiomyopathy
- Describe the diagnostic workup and various proposed criteria for left ventricular noncompaction (LVNC) cardiomyopathy
- Describe the role of cardiac MRI in the evaluation of left ventricular noncompaction (LVNC) cardiomyopathy
- Describe lifestyle counseling strategies for left ventricular noncompaction (LVNC) cardiomyopathy
- Describe the role of genetic evaluation for left ventricular noncompaction (LVNC) cardiomyopathy
- Describe the role of anticoagulation for left ventricular noncompaction (LVNC) cardiomyopathy
- Identify patients with left ventricular noncompaction (LVNC) cardiomyopathy who might benefit from automated implantable cardioverter defibrillator (AICD)
- Describe the management of left ventricular dysfunction and heart failure in patients with left ventricular noncompaction (LVNC) cardiomyopathy
- Identify factors that influence the prognosis of patients with left ventricular noncompaction (LVNC) cardiomyopathy
11-Cardiac Amyloidosis: General Principles
- Describe the different form of amyloidosis
- Describe the normal physiologic role of transthyretin
- Describe the pathogenesis of transthyretin (TTR) amyloidosis
- Describe the difference between wild-type and hereditary transthyretin (TTR) amyloidosis
- Identify common gene mutations associated with hereditary form of transthyretin (TTR) amyloidosis
- Describe the pathogenesis of AL amyloidosis
- Describe the difference and significance of primary and secondary AL amyloidosis
- Describe the cardiac manifestations of AL amyloidosis
- Describe the pathogenesis of AA amyloidosis
- Identify conditions associated with AA amyloidosis
- Describe how cardiac amyloid deposition can impair cardiac function
- Describe how the heart responds to cardiac amyloid deposition
- Describe the clinical findings associated with cardiac amyloidosis
- Describe the difference in cardiac involvement between AL and TTR amyloidosis
- Describe the diagnostic testing for and associated findings of amyloidosis
- Describe the value of genetic testing for TTR amyloidosis
- Describe the management strategies for cardiac amyloidosis
- Describe the goals of therapy in cardiac amyloidosis management
- Identify medications that should be avoided -- or used with caution -- in the context of cardiac amyloidosis
12-Cardiac Amyloidosis: ATTR
- Review the pathogenesis of cardiac amyloidosis and its various forms
- Describe the predominant clinical manifestations of transthyretin cardaic amyloidosis (ATTR)
- Describe the prognosis of transthyretin cardiac amyloidosis (ATTR)
- Describe cardiac and non-cardiac clinical manifestations of amyloidosis
- Describe the role of imaging in the evaluation of cardiac amyloidosis
- Describe the diagnostic evaluation of transthyretin cardiac amyloidosis (ATTR)
- Identify indications for endocardial biopsy in the evaluation of cardiac amyloidosis
- Describe the therapeutic approach for transthyretin cardiac amyloidosis (ATTR)
- Describe the management goals for transthyretin cardiac amyloidosis (ATTR)
- Describe the management of heart failure in patients with transthyretin cardiac amyloidosis (ATTR)
- Describe the management of electrical disorders in patients with transthyretin cardiac amyloidosis (ATTR)
- Describe the role of disease modifying therapies for transthyretin amyloidosis (ATTR) cardiomyopathy
- Describe the monitoring strategy for asymptomatic carriers of the TTR mutations
- Describe how to assess for disease progression of transthyretin amyloidosis (ATTR) cardiomyopathy
Contributors: Nandan Anavekar, MBBCh; Mahmoud Ismayl, MD; Khalid Saeed Al-Asad, MD; Adnan Halboni, MD; Adolfo Martinez Salazar, MD; Anthony Kashou, MD
Last updated: January 2023.
Français 
Español 
Deutsch 
日本 
Português 
हिन्दी 
中国人 
Italiano 
Dansk 
Suomalainen 
Norsk 
عربى