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The Curbsiders Internal Medicine Podcast

REBOOT #230 Kittleson Rules Heart Failure

The Curbsiders Internal Medicine Podcast

The Curbsiders Internal Medicine Podcast

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

4.83.1K Ratings

🗓️ 30 August 2021

⏱️ 75 minutes

🧾️ 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. Enjoy this Curbsiders classic and stay tuned this Wednesday, September 1, 2021 for a brand new CHF Triple Distilled episode.



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


Sponsor: BetterHelp
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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


Transcript

Click on a timestamp to play from that location

0:00.0

The Curbsiders podcast is for entertainment, education, and information purposes only,

0:07.1

and the topics discussed should not be used solely at Diagnostry, cure, or prevent any diseases

0:09.9

or conditions.

0:10.9

For the more the views and statements expressed on this podcast are solely those of those,

0:12.4

and should not be interpreted to reflect official policy or position of any entity

0:14.6

of the side-run possible, cash-like moral hospital, and affiliate outreach programs.

0:17.0

If indeed, there are any, in fact, there are none.

0:18.8

Pretty much we are responsible if you screw up, you should always do your own homework

0:20.7

and there's no way we're wrong.

0:32.2

Alright Paul, so let's take this again.

0:34.8

As you know, I did not like that first take, so let's take it again.

0:38.4

Welcome audience, this is the Curbsiders.

0:40.9

Tonight we'll be talking about inpatient management of Hard Failure with a fantastic guest, Dr.

0:45.8

Michelle Kittleson.

0:47.2

Before we tell you about her, Paul, tell the audience,

0:50.6

what do we do on the show?

0:52.4

Why are we here and why are we still doing this?

0:55.4

It's a great question.

0:56.9

I think we're learning that the more we repeat the same thing over and over again, the

1:00.4

more natural it becomes.

1:01.5

So I think this has been a learning exercise that I'm happy listeners get to see in real

1:04.8

time.

...

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