Acute Decompensated Heart Failure - Dr. Anderson Flashcards
Causes of ADHF
- Poor adherence
- Drugs: NSAIDs, decongestants, beta agonists
- Under treatment of HF
- Acute MI
- Progression of disease
What is a normal Cardiac Index (CI) value
- 2.8 to 4.2 L/min/m^2
- < 2.2 = Very poor perfusion
Normal Value for PAWP
- < 12mmHg
- >18 = fluid overload
Goal of Treatment for ADHF
- Improve signs/symptoms
- Stabilize hemodynamics
- Decrease mortality
Evidence for congestion/ fluid overload
- Orthopnea
- JVP
- Increasing S3
- Load P2
- Edema
- Ascites
- Rales
- HJR
Evidence of low perfusion
- Narrow pulse pressure
- Cool extremities
- ACEi related hypotension
- Declining Na+ levels
- Worsening renal function
Warm and Wet Treatment (subset II)
-IV diuretics
+/- vasodilators
Cold and Wet Treatment
subset IV
a) SBP > 90mmHg
-IV diuretics
+/- vasodilators
b) SBP < 90mmHg
-IV diuretics
-Inotropes
+/- mechanical vent
General Monitoring Parameters for ADHF Patients
- BUN
- SCr
- Daily electrolytes
- Ins and outs
- Vital signs
- Weight
When do you hold or reduce beta blocker therapy
- ONLY if recent initiation or increase in dose of beta blocker
- Marked volume overload
- Low cardiac output
When do you hold or reduce the dose of an ACEI/ARB/ARNI/ or aldosterone antagonist
-If patient’s renal function is significantly worsening
Is high or low dose of diuretics more effective in ADHF patients
-HIGH dose
Monitoring parameters for diuretics
- K+
- Mg2+
- BUN/Cr
- Blood pressure
- In’s and Out’s
- Daily weight
- Volume status
Monitoring parameters for Vasodilators
- Vitals
- HF symptoms
ex. Nitroprusside and nitroglycerine
Examples of Positive inotropes used in ADHF
- Dobutamine
- Dopamine
- Milirinone
