0201 Heart Failure Flashcards
LV Remodeling contributes to HF by ____
by the mechanical changes that happen to the wall (thinning that leads to increased aftrerload). Afterload mismatch
What are the goals of treating HF
Prevent/reverse remodeling
dyspnea caused by HF is multifactorial, most important mechanism is
Pulmonary congestion (accumulation of interstitial fluid)
orthopnea is a specific symptom of HF (T/F)
True
how to measure JVP? what is normal value?
45 degrees recumbent patient, measure water column from the sterna angle. Normal <8 cm
Chronic HF patients present with rales(T/F)
False, generally the lymphatic system adapts
what causes pleural effusion?
elevation of pleural capillary pressure–> transudation of fluid
the most useful index of LV function is ____
Ejection Fraction
the most useful index of LV function is ____
Ejection Fraction
What biochemical test can support HF in ambulatory patients
BNP nad NT-ProBNP
in HF patients Exercise testing is used to____
evaluate candidacy for Heart transplant
in HF patients Exercise testing is used to____
evaluate candidacy for Heart transplant
What is Cor Pulmonale
…
most common causes of Cor pulmonate in North America
COPD nad Chronic bronchitis (50% of For pulmonate patients)
What is the difference between pure right HF and Cor pulmonale
in both cases right HF
the etiology in Cor Pulmonale is Pulmonary
Most common symptom of Cor Pulmonale is___
dyspnea
Cor Pulmonale: Auscultation
S3 Gallop. RV heave on the left sternal border
What is P pulmonale (ECG)
Sharp P wave in inferior leads (2,3,aVF)
What is P pulmonale (ECG)
Sharp P wave in inferior leads (2,3,aVF
what are the targets for treating HFpEF?
Control congestion,
stabilize of heart rate and blood pressure
improve exercise tolerance
Typical ADHF management principals
if Hypertensive: Vasiodialators
if Nomotensive: Diuretics
In ADHF patients when should you use pulmonary catheters: A. Always B. High BUN C. Low Cardiac output, D. Poor response do diuresis
C+D
Low cardiac output signs I=(Hypotension), or poor response to diuresis
When is IV administration of Diuretics recommended in ADHF patients?
when there is impaired response to oral treatment:
requiring very high doses of oral diuretics.
or subotimal effect of diuresis
When treatingg ADHF when is metolazone recommended?
patients receiving longterm therapy with loop diuretics
How do you decide on discharging ADHF?
Physcial examination (normal JVP) coupled with positive trends in biomarkers
the problem with long-term inotropic treatment in ADHF is ___
increased mortality
When should Dobutamine and milrinone be give in the context of ADHF
in hospitalized patients with documented systolic dysfunction, short-term and a s bridge therapy for patients awaiting transplant
When is milrinone proffered over dobutamine
milrinone acts downstream to the Beta1-adrenergic receptor and thus can be given to patients on beta blockers
Increasing ACEi dosage in HFrEF improves survival (T/F)
False
Increasing B-Blocker dosage in HFrEF patients improves survival (T/F)
True
HFrEF: Mineralocorticoids
Aldosterone antagonists reduce mortality in NYHA II to IV. Reduction in Suddden Cardiac Death.
HFrEF: Mineralocorticoids (side effects)
Hyperkalemia. Beware in CKD, and Renal Failure patients
Angiotensin levels can return normal after ACEi treatment in hFrEF patients (T/F)
True
Callede Neurohormonal escape
How do you deal with neurohormonal escape in HFrEF patients receiving B-Blockers and ACE-i
switch to ACEi and ARB.
The initial clinical strategy in HFrEF patients is (x)-drug combination…
Thus, the initial clinical strategy should be to use
a two-drug combination first (ACEI and beta blocker; if beta blocker
intolerant, then ACEI and ARB; if ACEI intolerant, then ARB and beta
blocker). In symptomatic patients (NYHA class II–IV), an aldosterone
antagonist should be strongly considered, but four-drug therapy
should be avoided.
