Heart Failure Exacerbation: Key Pearls, Differentials & Treatment Strategies! (Intern 101 Series!)

Hi I'm Prerak Juthani - an internal medicine resident at Stanford! I am here to discuss the fundamentals of Heart Failure! Heart failure (HF) is a complex clinical syndrome characterized by symptoms and signs resulting from any structural or functional impairment of ventricular filling or ejection of blood. It is typically manifested by dyspnea, fatigue, exertional intolerance, and fluid retention. This video will summarize the nuances of Heart Failure for all medical students and early stage residents. I hope it is helpful!

Different ways to connect with me (so sorry in advance it takes me a bit to respond since residency is destroying my time haha):
- LinkedIn (publications, professional stuff I'm up to!): https://www.linkedin.com/in/prerakjuthani
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- My Podcast: https://podcasts.apple.com/us/podcast/red-white-brown/id1505136595

Here are some of my more popular videos:
- Anki: All You Will Ever Need PLAYLIST: https://www.youtube.com/playlist?list=PLoRUsKSPCHAYv6OnDZQnb_TjGn6WGIpud

- How to Make Anki Cards from Med School Lectures (Part 1): https://www.youtube.com/watch?v=ye89MBXPPws&list=PLoRUsKSPCHAYv6OnDZQnb_TjGn6WGIpud&index=14&t=47s

5 HUGE Limitations of ANKI (...And How to Get Around Them!): https://www.youtube.com/watch?v=nMHU_mu_elU&list=PLoRUsKSPCHAYv6OnDZQnb_TjGn6WGIpud&index=29

- How to EFFECTIVELY CRAM Using Anki (College Classes + Med School): https://www.youtube.com/watchv=8w47pZtFCs0&list=PLoRUsKSPCHAYv6OnDZQnb_TjGn6WGIpud&index=30

- 5 SIMPLE Ways to UP Your Anki Game! (EVERYTHING You Need; Strategies for ALL Subjects):
https://www.youtube.com/watchv=1RfrWC9oq8M&list=PLoRUsKSPCHAYv6OnDZQnb_TjGn6WGIpud&index=31

TIME STAMPS:
00:00-00:50 - The FUNDAMENTALS of Heart Failure

00:51-01:31 - Source for This Video
- Core IM Podcast: https://www.coreimpodcast.com/2020/06/24/5-pearls-on-inpatient-heart-failure/
- Wiki Journal Club: https://www.wikijournalclub.org/wiki/Main_Page
- The podcast above discusses 5 Pearls on Inpatient Heart Failure. Including them below:
"Pearl 1: Presence of an S3 is a specific sign of overload in heart failure. Crackles and rales are neither sensitive nor specific for pulmonary edema in chronic heart failure
Pearl 2: High creatinine does signify it will be a more complex diuresis
Pearl 3: Spironolactone helps with long term remodeling and potassium sparing properties
Pearls 4 and 5: In the warm and wet patient, rapid diuresis is ok in a patient who can hemodynamically tolerate. Don’t fear the ins and outs. Lets the patient guide you!"

01:32-03:11 - Casting a BROAD Differential for Chest Pain!
- TL;DR - Chest Pain is NOT ALWAYS A HEART PROBLEM!

03:12-05:00 - What is the Classic Presentation of Heart Failure?
- The Heart Failure Society of America defines HF as a syndrome caused by cardiac dysfunction, generally resulting from myocardial muscle dysfunction or loss, and characterized by left ventricular dilation or hypertrophy. This dysfunction can be primarily systolic, diastolic, or mixed, leading to neurohormonal and circulatory abnormalities.
HF can be classified based on left ventricular ejection fraction (LVEF) into:
• Heart failure with reduced ejection fraction (HFrEF): LVEF ≤ 40%
• Heart failure with mildly reduced ejection fraction (HFmrEF): LVEF 41-49%
• Heart failure with preserved ejection fraction (HFpEF): LVEF ≥ 50%
• Heart failure with improved ejection fraction (HFimpEF): Baseline LVEF less than 40%, with a ≥10-point increase from baseline and a second measurement of LVEF greater 40%.

05:01-5:31 - A Small Aside on HFpEF (what even is it?)

05:31 -8:14 - Important Question to Ask Someone with Heart Failure! (+ What Labs to Get!)

08:15 -10:24 - How to Treat Someone with Heart Failure!
- I also go over the basics of heart failure treatment with diuretics and I also discuss how to convert between different diuretic doses.

10:25 -12:21 - What the HECK is GDMT (Guideline Directed Medical Therapy)?
- These are things that have been shown to help individuals with acute heart failure exacerbation and HFrEF (fewer than 40%).
- There are also medications that have been shown to help individuals with HFpEF.