BLOCK 6: Heart Failure and Cardiomyopathies
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Learning Objectives By Lesson
1-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.
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