8 Acute Heart Failure Flashcards
Symptom with the highest sensitivity for heart failure
Dyspnea on exertion (84%)
Most specific symptoms for HF
- PND
- Orthopnea
- Edema
Physical Exam with the highest positive likelihood ratio for Acute HF
S3
Age specific cut-offs for NTproBNP
<50 y/o: 450 pg/mL
50-75: 900 pg/mL
>75 y/o: 1800 pg/mL
Three questions addressed by bedside POCUS for heart failure
- Signs of pulmonary congestion
- Signs of volume overload
- Left ventricular ejection fraction
POCUS findings specific for alveolar and interstitial edema (pulmonary congestion)
> 2 B lines in any one sonographic window along the anterior and antero lateral chest
OR
B line count in all 8 zones > or = 10
Bedside POCUS findings indicative of elevated central venous pressure
IVC of >2cm or collapsibility index of <50%
Dose of sublingual nitroglycerin
400 mcg (0.4 mg)
Starting dose of IV niyroglycerin and its maximum dose
0.5 - 0.7 mcg/kg/min
Max dose of 200 mcg/min
Most important nitroglycerin complication
Hypotension
BP cut off for starting IV NTG
> 150/100
68 yr old male, BP of 170/100, PR 110, RR 28 on bipap, 98% sats, Temp 36.6. Already hooked to IV NTG. What is the next line of medication for controlling BP? (Indicate initial dose and maximum dose)
IV nitroprusside
Starting dose: 0.3 mcg/kg/min
Maximum dose: 10mcg/kg/min
65y/o male, ADHF, BP 130/90, PR 110, RR 24, O2 96 at 6lpm, T 36.6. Patient is maintained on Furosemide 80mg/tab BID. What is the dose for furosemide bolus at the ED level?
Furosemide 80-200mg IV bolus
(Starting point of IV diuretic dosing is 1-2.5x the patients previous total daily oral dose, divided by half and administered IV bolus every 12 hours)
Reasonable starting dose of furosemide for patients with Acute HF who is loop diuretic naive?
Furosemide 40mg IV bolus
Acute HF can be ruled out in dyspneic patients with BNP of _____ or NT proBNP of ______
BNP of <100 pg/mL
NT pro BNP of <300 pg/mL
