BROADCASTS.com

The following question refers to Section 4.1 of the\xa02022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.\xa0The question is asked by Texas Tech University medical student and CardioNerds Academy Intern\xa0Dr. Adriana Mares, answered first by Baylor University cardiology fellow and CardioNerds FIT Trialist\xa0Dr. Shiva Patlolla, and then by expert faculty\xa0Dr. Eldrin Lewis.\nDr. Lewis is an Advanced Heart Failure and Transplant Cardiologist, Professor of Medicine and Chief of the Division of Cardiovascular Medicine at Stanford University.\nThe\xa0Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure\xa0series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders\xa0Dr. Amit Goyal\xa0and\xa0Dr. Dan Ambinder, with mentorship from\xa0Dr. Anu Lala,\xa0Dr. Robert Mentz, and\xa0Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.\nEnjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values.\t\t\n\t\t\t\t\t\t\t\t\t\t\t\tQuestion #4\n\t\t\t\t\t\n\n\n\nMr. Stevens is a 55-year-old man who presents with progressively worsening dyspnea on exertion for the past 2 weeks. He has associated paroxysmal nocturnal dyspnea, intermittent exertional chest pressure, and bilateral lower extremity edema. Otherwise, Mr. Stevens does not have any medical history and does not take any medications.\xa0\nWhich of the following will be helpful for diagnosis at this time?\n\n\n\n\nA\n\n\n\xa0Detailed history and physical examination\n\n\n\n\nB\n\n\n\xa0Chest x-ray\n\n\n\n\nC\n\n\n\xa0Blood workup including CBC, CMP, NT proBNP\n\n\n\n\nD\n\n\n\xa012-lead ECG\n\n\n\n\nE\n\n\nAll of the above\n\n\n\n\n\xa0\n\t\t\t\t\t\t\t\t\t\t\t\tAnswer #4\n\t\t\t\t\t\n\n\n\n\xa0\n\n\nThe correct answer is E \u2013 All of the above.\xa0\nMr. Stevens presents with signs and symptoms of volume overload concerning for new onset heart failure. The history and physical exam remain the cornerstone in the assessment of patients with HF. Not only is the H&P valuable for identifying the presence of heart failure but also may provide hints about the degree of congestion, underlying etiology, and alternative diagnoses. As such H&P earns a Class 1 indication for a variety of reasons in patients with heart failure:\n1.\xa0\xa0\xa0\xa0\xa0\xa0 Vital signs and evidence of clinical congestion should be assessed at each encounter to guide overall management, including adjustment of diuretics and other medications (Class 1, LOE B-NR)\n2.\xa0\xa0\xa0\xa0\xa0\xa0 Clinical factors indicating the presence of advanced HF should be sought via the history and physical examination (Class 1, LOE B-NR)\n3.\xa0\xa0\xa0\xa0\xa0\xa0 A 3-generation family history should be obtained or updated when assessing the cause of the cardiomyopathy to identify possible inherited disease (Class 1, LOE B-NR)\n4.\xa0\xa0\xa0\xa0\xa0\xa0 A thorough history and physical examination should direct diagnostic strategies to uncover specific causes that may warrant disease-specific management (Class 1, LOE B-NR)\n5.\xa0\xa0\xa0\xa0\xa0\xa0 A thorough history and physical examination should be obtained and performed to identify cardiac and noncardiac disorders, lifestyle and behavioral factors, and social determinants of health that might cause or accelerate the development or progression of HF (Class 1, LOE C-EO)\nBuilding on the H&P, laboratory evaluation provides important information about comorbidities, suitability for and adverse effects of treatments, potential causes or confounders of HF, severity and prognosis of HF, and more. As such, for patients who are diagnosed with HF, laboratory evaluation should include complete blood count, urinalysis, serum electrolytes, blood urea nitrogen, serum creatinine, glucose, lipid profile, liver function tests, iron studies, and thyroid-stimulating hormone to optimize management (Class 1, LOE C-EO). In addition, the specific cause of HF should be explored using additional laboratory testi...