#230 Kittleson Rules Acute Heart Failure

The Curbsiders Internal Medicine Podcast

Health & Fitness, Medicine, Science, Higher Education, Education

4.8 • 3.1K Ratings

🗓️ 17 August 2020

⏱️ 72 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

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.

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

Transcript

Click on a timestamp to play from that location

0:00.0	The Curbsiders podcast is for entertainment, education, and information purposes only.
0:07.0	And the topics discussed should not be used solely to die in a street cure or prevent any
0:09.6	diseases or conditions.
0:10.6	For the more the views and statements expressed on the podcast are solely those of those
0:12.3	that should not be interpreted to reflect official policy or position of any entity
0:14.6	that's either on possibly cash like more hospital and affiliate outreach programs.
0:16.8	If indeed there are any, if you fact there are none.
0:18.8	Pretty much we aren't responsible if you screw up, you should always do your own homework
0:20.6	and let's know if we're wrong.
0:31.0	Alright Paul, so let's take this again.
0:34.3	As you know, I did not like that first take.
0:36.6	So let's take it again.
0:38.3	Welcome audience.
0:39.3	This is the Curbsiders.
0:40.9	Tonight we'll be talking about inpatient management of Hard Failure with a fantastic
0:45.0	guest Dr. Michelle Kittleson.
0:47.3	Before we tell you about her, Paul tell the audience, what do we do on this show?
0:52.4	Why are we here and why are we still doing this?
0:55.4	It's a great question.
0:56.8	I think we're learning that the more we repeat the same thing over and over again, the
1:00.3	more natural it becomes.
1:01.3	So I think this has been a learning exercise that I'm happy listeners get to see in real
	...

Please login to see the full transcript.

Previous episode | Next episode

Disclaimer: The podcast and artwork embedded on this page are from The Curbsiders Internal Medicine Podcast, and are the property of its owner and not affiliated with or endorsed by Tapesearch.

Generated transcripts are the property of The Curbsiders Internal Medicine Podcast and are distributed freely under the Fair Use doctrine. Transcripts generated by Tapesearch are not guaranteed to be accurate.