Acute Decompensated Heart Failure and Transitions of Care Flashcards
What are the two presentations
Rapidly developing symptoms of new-onset heart failure, gradual worsening of chronic heart failure
T/F: To be considered heart failure there must be ejection fraction less than 50%
True
What causes of ADHF
Respiratory infection, Ischemia/ACS, Arrhythmia, uncontrolled HTN, nonadherence to meds, worsening renal function, nonadherence to diet
What are “wet” (volume overload) symptoms
peripheral edema, pulmonary edema, cough, worsening DOE (difficulty breathing) and orthopnea (difficulty breathing laying down), anorexia/early satiety
What are “cold” (low cardiac output) symptoms
decreased urine output, elevated BUN/SCr, tachycardia, cold and clammy extremities, decreased exercise tolerance, fatigue
What peptide is a marker for increased preload
BNP
What are ways that can alter the BNP
Obesity (lower), renal insufficiency, acute coronary syndrome, atrial fibrillation
What are the four hemodynamic subsets of ADHF
Class 1: Warm (good cardiac output/good perfusion), dry (good volume)
Class 2: Warm, wet (volume overload)
Class 3: cold (low cardiac output/bad perfusion), dry
Class 4: cold, wet
What are the two most common presentations for ADHF
Class 2 and Class 4
T/F: Negative ionotropes including beta-blockers make heart failure worse
False: Negative ionotropes excluding beta-blockers make heart failure worse
What are the three types of drugs that will be used to deal with acute heart failure
Loop Diuretics, Inotropes, Vasodilators
What would the dose of IV loop diuretics be if this is there first time with HF, chronic HF patients, maximum dose
20-80 mg IV every 8-12 hours, total daily dose is equal to the INITIAL IV dose, 200-250 mg dose
What is the goal urine output for each dose when using IV loop diuretics to treat HF, each day
250-500 mg within 2 hours of dose, 1.5-2 L of NET diuresis
What is the initial reason to increase IV diuretics, how can it be treated
Inadequate response to initial diuretic regimen, double the IV dose
What should be done if there is an inadequate response to the increase diuretic dose
Continous fusion OR add metalazone by mouth, spironolactone by mouth, or chlorothiazide IV
What is the last resort if all IV diuresis options fail
Consider ultrafiltration
When would it be okay to add an IV vasodilator to a treatment regimen for AHF, indications
Symptomatic hypotension is absent/ Acute pulmonary edmema, need for rapid improvement of symptoms, pulmonary congestion refreactory to IV diuresis
What are the two IV vasodilators that are used, what is the MOA
Nitroglycerin and Nitroprusside, Nitrous oxide donors
T/F: There is no reduction in re-hospitalization or mortality when using IV vasodilators for AHF
True
Which IV vasodilator is preferred in patients with coronary ischemia, balanced arterio-/venodilation (more potent)
Nitroglycerin, nitroprusside
what are the indications for using IV inotropes
Diminshed peripheral perfusion or end-organ dyfunction, marginal systolic BP (greater than 90), symptomatic hypotension, palliative therapy for Stage D patients
T/F: Long term use of inotropes lowers mortality
False: Long term use without proper indications is associated with increased mortality
What is the MOA of inotropes, what are the IV inotropes
Increase cAMP increasing myocardial contractility/ Dobutamin and milrinone
Which is IV inotrope that it is more likley to cause hypotension due to vasodilation and is eliminated renally, has vasodilation at higher doses and hepatically eliminated
Milrinone, dobutamine
What adverse effects of using either IV inotrope
Proarrhythmia and tachycardia, coronary ischemia
What drug class are used for Class 2, Class 3, and Class 4 for ADHF
Class 2: Diuretics +/- vasodilators
Class 3: Inotropes +/- vasopressors
Class 4: Inotropes + diuretics
What are pharmacological options patients should also receive for VTE prophylaxis/non pharmacological prophylaxis
Unfractionated Heparin, LMWH, Fondaparinux/Intermittent pneumatic compression devices and compression stockings
T/F: Weight, fluid intake/output, electrolytes, and renal function should be checked daily
True
T/F: If a patient goes to the hospital for AHF they should be given an improved regimen
True