Acute Decompensated Heart Failure Flashcards
True or false: Most HF hospitalizations for decompensation are acute
False. Most are not truly acute, they occur as a result of gradual filling pressures on preexisting structural heart disease
What are two big factors in acute decompensated heart failure?
. Medication related- non adherence
. Disease related- non adherence to fluid/sodium restrictions, MI, uncontrolled HTN
Components that help in diagnosis of ADHF
. Detailed history and physical exam
. BNP or NT-pro-BNP
. Hemodynamic monitoring
Patients taking Entresto should have what lab value monitored?
pro-BNP
What are the four categories of ADHF clinical presentation? What do they mean?
I- Warm and dry
II - Warm and wet
III - Cold and dry
IV - Cold and wet
Wet/dry = fluid status
Warm/cold = cardiac function
At what BNP and pro-BNP levels do you exclude ADHF in patients with dyspnea of unknown etiology?
BNP < 100
NT-proBNP < 300
_____-_____ is an invasive method of hemodynamic monitoring and is not recommended
Swan-Ganz
True or false: Hospitalization for heart failure is considered a sentinel event
True
What are the three main drug classes used in ADHF?
. Diuretics
. Inotropes
. Vasodilators
General management for cold and dry subset
. PCWP < 15 = IVF until 15 - 18
. PCWP > 15, SBP < 90 = Inotrope
. PCWP > 15, SBP ≥ 90 = Vasodilator
General management for warm and dry subset
Optimize PO medications
General management for warm and wet subset
IV diuretics
General management for cold and wet subset
IV diuretics ±
SBP < 90 = Inotrope ( + vasopressor)
SPB ≥ 90 = Vasodilator
What are indicators of hemodynamic instability?
. Change in mental status
. SBP <90
. Cold and clammy
. Ongoing chest pain
What drug class is considered first line treatment for ADHF associated with fluid overload? Which medication in this class is most commonly used?
Diuretics. Furosemide
An ADHF patient hospitalized for fluid overload should be given the IV equivalent of ____ times their at home oral diuretic dose
a. 2
b. 2.5
c. 3
d. 4
d. 4
Which medication class is used in conjunction with diuretics to manage pulmonary congestion in subset II or IV of HF?
Vasodilators
Which medication can be used instead of inotropes in patients with elevated SVR and low CO?
Nitroprusside
Most patients have evidence of congestion (with/without) apparent hypoperfusion
Without
Which types of diuretics are used in treating ADHF?
. Loop diuretics
. Thiazide diuretics
