13 Acute HF Flashcards
etiology/patho
- includes with both HF ___ and HF ___
- acute worsening of ___ HF accounts for 70% if cases (patients become refractory due to a realtively mild insult)
- new acute HF is ~25% of cases
- progressive worsening of ___ in chronic HF ~5% of cases
- cardiogenic shock: hypotension (SBP < ___ mmHg or MAP < ___ mmHg) with low ___
- HFrEF, HFpEF
- chronic
- CO
- 90, 70, CO
Diagnostic Tools
non-invasive
detailed physical exam
- congestion
- adequacy of perfusion
lab assessment
- Cr, K, Na
- BNP and NTproBNP > ___ is closely associated with acute HF
400
Diagnostic Tools
invasive hemodynamic monitoring
- routine use is discouraged
- flow directed PA catheters ( ___ catheters)
Swan-Ganz
Maintaining Chronic Therapy While Hospitalized
GDMT should be continued in the absence of hemodynamic instability or CI (hypotension/cardiogenic shock)
Caution with aggressive diuresis and ___ / ___
- caution with increases and titrating up
- increases in SCr (~ ___ %) do not worsen outcomes
RAASi/SGLT2i
20%
Maintaining Chronic Therapy While Hospitalized
Beta Blockers
- do not stop unless recent initiation or up-titiration resulted in current decompensation
- consider holding if ___ is needed or if hemodynamicaly ___
- do not add or up titrate until optimizational of volume status and successful D/C of IV diuretics, VDs and inotropes
dobutamine, unstable
Maintaining Chronic Therapy While Hospitalized
digoxin
- continue at a dose to achieve SDC ___ - ___ ng/mL
- avoid D/C unless compelling reason
- caution with regard to renal function
0.5-0.9
management of decompensated episodes
- diuretics, inotropes, vasodilators, vasopressors
- no therapy shown to reduce mortality
drug therapy by classification
warm and dry
optimize chronic therapy
drug therapy by classification
warm and wet
IV diuretics +/- venous vasodilator
drug therapy by classification
cold and dry
- if PCWP < 15: IV ___ until PCWP 15-18
- if PCWP > 15 and SBP < 90: IV ___
- if PCWP > 15 and SBP > 90: IV ___ or arterial ___
- fluids
- iontrope
- inotrope, arterial vasodilator
cold and wet
IV ___ and
if SBP < 90: IV ___
if SBP > 90: IV ___
diuretics
- inotrope
- arterial vasodilator
Diuretics in hospitalized patients
- used primarily to treat systemic/pulmonary ___ in subset ___ or ___
- first line agents with fluid overload
- initial IV dose should equal or ___ the chronic daily dose and be given as an intermittent bolus
- loops more widely used; THZ used as add-on if refractory
if resistance
- ___ and ___ restriction
- increase ___ rather than ___ to ceiling
- add THZ
- ultrafiltration
congestion, II, IV
exceed
Na, water
dose, frequency
diuretics in hospitalized patients
dosing
- increase dose patient was receiving at home
- if contiuous infusion: furosemide ___ mg/kg/hr doubled q2-4 hours; max ___
monitoring
- urine output and s/s of congestion
- ins/outs, body weight, vital signs, s/s perfusion and congestion
- desire ___ - ___ L/day above input ealy
0.1, 0.4
1-2
loop diuretics
furosemide ( ___ )
use
- fluid overload ( ___ )
PO/IV equivalent dose: ___ / ___
initial bolus and infusion rate
- ___ - ___ (10 mg/hr)
duration or response: ___ hours
AE
- Mg and K depletion
- hypotension
- worsened renal function
Lasix
- wet
- 80/40
- 40-120
- 2
loop diuetics
bumetanide ( ___ )
use
- fluid overload ( ___ )
PO/IV equivalent dose: ___ / ___
initial bolus and infusion rate
- ___ - ___ (0.5mg/hr)
duration or response: ___ hours
AE
- Mg and K depletion
- hypotension
- worsened renal function
Bumex
- wet
- 1/1
- 1-4
- 6
loop diuretics
torsemide ( ___ )
use
- fluid overload ( ___ )
PO/IV equivalent dose: ___ / ___
initial bolus and infusion rate
- ___ - ___ (0.5 mg/hr)
duration or response: ___ hours
AE
- Mg and K depletion
- hypotension
- worsened renal function
Demadex
- wet
- 20/20
- 10-40
- 6
positive inotropes
beta-agonists (2)
PDE 3 inh (2)
- dobutamine
- dopamine
- milrinone
- amrinone
amrinone isnt used
positive inotropes ___ curve
raise
