268.2 📚 國考版

268.2.0.1 必背 — HF Classification by EF

  • HFrEF: ≀ 40%
  • HFmrEF: 41-49%
  • HFpEF: ≥ 50%
  • HFimpEF: HFrEF that recovered to > 40%

268.2.0.2 必背 — ACC/AHA Stages

  • A (At Risk): risk factors, no structural disease
  • B (Pre-HF): structural disease, no symptoms
  • C (HF): structural + symptoms (current or prior)
  • D (Advanced HF): refractory, advanced therapies

268.2.0.3 必背 — NYHA Functional Class

  • I: no limitation
  • II: slight (ordinary activity → symptoms)
  • III: marked (less than ordinary → symptoms)
  • IV: symptoms at rest

268.2.0.4 必背 — Pathophysiology

  • Neurohormonal activation (RAAS + sympathetic) — initially compensatory, ultimately maladaptive
  • Cardiac remodeling (LV dilation, hypertrophy, fibrosis)
  • Natriuretic peptides counter-regulatory (BNP)

268.2.0.5 必背 — HFrEF Etiologies

  • Ischemic (#1; post-MI)
  • DCM (idiopathic, familial, viral, alcohol, anthracycline, peripartum)
  • Valvular
  • Hypertensive (later stage)
  • Infiltrative (amyloid in some)

268.2.0.6 必背 — HFpEF Etiologies

  • Hypertension (#1)
  • Aging
  • Obesity + metabolic syndrome
  • DM
  • AF
  • Restrictive CM (amyloid)
  • HCM

268.2.0.7 必背 — Symptoms + Signs

  • Symptoms: dyspnea (exertional, orthopnea, PND), fatigue, edema
  • Signs: elevated JVP, crackles, S3 (HFrEF) / S4 (HFpEF), peripheral edema, hepatomegaly

268.2.0.8 必背 — Diagnostic Tests

  • ECG: rhythm, ischemia, conduction
  • CXR: cardiomegaly, congestion
  • Echo: EF, chambers, valves, diastolic function
  • BNP / NT-proBNP: elevated supports HF
  • CMP, CBC, thyroid, lipid, HbA1c, iron
  • Cardiac MRI (etiology workup)
  • Coronary angiography (suspected ischemic)
  • RHC for advanced HF / pulmonary HTN / pre-transplant

268.2.0.9 必背 — BNP Cutoffs

  • BNP < 100: unlikely HF
  • BNP > 400: HF likely
  • NT-proBNP < 300: unlikely HF
  • Age-adjusted cutoffs for NT-proBNP

268.2.0.10 必背 — ADHF Phenotypes

  • Wet + Warm: volume overload, normal perfusion → diuretic
  • Wet + Cold: volume + poor perfusion → diuretic + inotrope
  • Dry + Cold: low-output → inotrope
  • Dry + Warm: compensated → optimize chronic therapy

268.2.0.11 必背 — ADHF Acute Management

  • IV diuretics + oxygen + NIV (severe pulmonary edema) + vasodilator (HTN) + inotrope (low-output) + mechanical support (refractory)

268.2.0.12 必背 — Worsening Triggers

  • Non-adherence + dietary indiscretion + AF + ischemia + infection + PE + anemia + NSAIDs + thyroid + renal failure

268.2.0.13 必背 — 2022 Universal HF Definition (Lancet)

  • Symptoms + signs + objective evidence (BNP/NT-proBNP elevated OR objective cardiac dysfunction on imaging)