268.3 🩺 內科專科考前版

268.3.0.1 1⃣ HFpEF Diagnosis Challenges

  • HFpEF is heterogeneous syndrome
  • HFA-PEFF score for diagnosis
  • E/e’ > 14, LA dilation, LVH, BNP elevated
  • Exclude other causes (valvular, pericardial, infiltrative)
  • Diastolic dysfunction grades

268.3.0.2 2⃣ Cardiac Amyloidosis Workup (HFpEF Phenotype)

  1. Suspect with HFpEF + LVH + low ECG voltage + bilateral CTS
  2. Free light chains (FLC) + serum/urine protein electrophoresis (AL screening)
  3. Echo: apical sparing strain (cherry-on-top); LA dysfunction
  4. CMR: subendocardial circumferential LGE; ECV elevated
  5. PYP scan: ATTR (if FLC negative)
  6. Biopsy for AL (fat pad, bone marrow, or cardiac)
  7. Subtype determination for treatment

268.3.0.3 3⃣ HFimpEF (Improved EF)

  • Patients previously with HFrEF whose EF improves to > 40%
  • Continue GDMT (don’t stop)
  • TRED-HF trial: discontinuation of meds → 40% relapse
  • Lifelong guideline-directed medical therapy

268.3.0.4 4⃣ Cardio-Oncology Concerns

  • Anthracycline (doxorubicin) cumulative dose-dependent cardiotoxicity
  • Trastuzumab (HER2) reversible LV dysfunction
  • Immune checkpoint inhibitors (PD-1/L1) — myocarditis (rare but serious)
  • TKI cardiotoxicity (variable)
  • Pre-treatment + serial echo + GLS monitoring
  • Cardio-oncology specialty

268.3.0.5 5⃣ Peripartum Cardiomyopathy

  • Pregnancy / postpartum (up to 6 mo postpartum)
  • Exclude other causes
  • Diuretics, ACEi/ARB (avoid in pregnancy), β-blocker
  • Postpartum: standard HFrEF therapy
  • ~ 30-50% recover EF; 10-20% remain reduced

268.3.0.6 6⃣ Tachycardia-Induced Cardiomyopathy

  • Sustained tachycardia (AF, AVNRT, AVRT, etc.) → LV dysfunction
  • Reversible with rhythm control / rate control
  • Common in AF + uncontrolled rate
  • Catheter ablation often curative
  • Suspect in unexplained HFrEF with arrhythmia

268.3.0.7 7⃣ Iron Deficiency in HF

  • Common in HF (40-50% prevalence)
  • Worsens functional capacity + outcomes
  • IV iron (ferric carboxymaltose, ferric derisomaltose) for symptomatic HFrEF
  • CONFIRM-HF, FAIR-HF, AFFIRM-AHF trials
  • Improves exercise capacity + QoL

268.3.0.8 8⃣ 健保 / Taiwan

  • 健保 HF management widely available
  • BNP/NT-proBNP covered
  • Echo + cardiac MRI available
  • Multidisciplinary HF programs in tertiary centers

268.3.0.9 9⃣ Worsening HF Recognition

  • Weight gain (> 2-3 kg in 2-3 days)
  • New / worsened dyspnea
  • Orthopnea / PND
  • Increased edema
  • Decreased exercise tolerance
  • Patient self-management programs reduce hospitalizations

268.3.0.10 10. Future + Innovations

  • AI-ECG: LVEF estimation, HF prediction
  • Implantable hemodynamic monitors (CardioMEMS)
  • Remote monitoring + telehealth
  • mRNA-based therapies for cardiomyopathy in development
  • Cardiac regeneration research