#230 Kittleson Rules Acute Heart Failure

Does the thought of managing acute decompensated heart failure (ADHF) give you paroxysmal nocturnal dyspnea?  Recline for a bit while Dr. Michelle Kittleson MD, PhD @MKittlesonMD (Cedars Sinai) takes us through the Zen of jugular venous pressure (JVP) exams, how to approach diuresis, and the fine points of hospital discharge. This knowledge food is easier to swallow than an oral potassium replacement.

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Credits

• Written and Produced by: Deborah Gorth ScM
  
• Cover Art and Infographic by: Edison Jyang
  
• Hosts: Matthew Watto MD, FACP and Paul Williams MD, FACP
  
• Editor: Cyrus Askin MD (written materials); Clair Morgan of nodderly.com
  
• Guest: Michelle Kittleson MD, PhD
  

Sponsor - VCU Health CE

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.

Time Stamps

• 00:00 Intro
  
• 02:40 Guest one-liner; Picks of the Week
  
• 08:33 Case from Kashlak part 1, Definition of acute decompensated heart failure (ADHF), Factors that lead to ADHF (FAILURE mnemonic)
  
• 13:39 Historical clues for ADHF; Is salt restriction needed? Fluid restriction?
  
• 20:42 More on History and Physical exam for ADHF; JVP exam in detail; Crackles are worthless?!
  
• 28:36 Labs to trend during an ADHF admission
  
• 33:15 Recap of history, physical exam, and initial approach; Initiating diuresis; Goal urine output; Diuresis in HFrEF vs HFpEF phenotypes
  
• 45:32 Diuretic resistance and when to use a drip, metolazone; Do K and Mg need to be 4 and 2?
  
• 49:05 When to hold guideline directed medical therapy (Beta blockers, ARNI, ACEI/ARB)
  
• 56:05 Who needs a right heart cath?
  
• 59:30 Endpoints for discharge; Switch to PO diuretics; Approach to discharge and transitions of care
  
• 64:04 SGLT2i in heart failure
• 68:15 Take home points and outro