REBOOT #230 Kittleson Rules 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. Enjoy this Curbsiders classic and stay tuned this Wednesday, September 1, 2021 for a brand new CHF Triple Distilled episode.

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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: Ten Thousand tenthousand.cc

Head to tenthousand.cc and enter our code CURB at checkout to save 15%. 

Sponsor: BetterHelp betterhelp.com/curb

​​Special offer for Curbsiders listeners: get 10% off your first month at betterhelp.com/curb    

Time Stamps*

Time Stamps refer to ad-free version

00:00 Intro, disclaimer, guest bio

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