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.

Listeners can claim Free CE credit through VCU Health at curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).

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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. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.

Time Stamps 00:00 Sponsor - VCU Health CE; 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 Sponsor - VCU Health CE Links* Dr. Kittleson’s go-to brownie recipe My Own Country: A Doctor’s Story by Abraham Verghese The new Run the Jewels album RTJ4 #KittlesonRules Practice Tests for Jeopardy Core IM podcast about Salt Restriction in Heart Failure
*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal Listeners will learn how to manage acute decompensated heart failure.

Learning objectives After listening to this episode listeners will…
Learn the basic pathophysiology of acute decompensated heart failure (ADHF) Develop a framework for the approach to diuretic therapy Gain the tools to effectively monitor the progress of diuresis Develop strategies to approach diuretic resistance Establish criteria for discharge and strategies to reduce readmission Know which drugs reduce mortality for heart failure with reduced ejection fraction (HFrEF)
Disclosures Dr Kittleson reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.

Citation Kittleson MM, Gorth DJ, Williams PN, Watto MF. “#230 Kittleson Rules Heart Failure”. The Curbsiders Internal Medicine Podcast. thecurbsiders.com/episode-list Final publishing date August 17, 2020.