Acute Decompensated HF

Question 1

Heart failure is characterized by _______

Answer 1

1. Ventricular dysfunction
2. Reduced exercise tolerance
3. Diminished quality of life
4. Shortened life expectancy

Question 2

IV push furosemide (Lasix) for ADHF
Action
Rate of administration
Dose

Answer 2

Action: reduces venous return & preload, decrease intravascular volume
Rate: 4 mg/min
Dose: 40 mg

Question 3

Digoxin
Drug class
Mechanism of action
Monitor
S/S toxicity
Antidote
Hypokalemia...

Answer 3

Class: cardiac glycoside
Action: positive inotrope (improves force of contraction), increases O2 demand
Monitor: apical pulse! *
S/S toxicity: yellow halo, N/V, heart block & dysrhythmias
Antidote: digibind
Hypokalemia: one of the most common causes of dig toxicity…enhances the action of dig

Question 4

Hallmark finding in systolic HF?

Answer 4

decreased left ventricular ejection fraction (EF)

Question 5

What do you know about ejection fraction in mixed systolic and diastolic failure?

Answer 5

Poor! <35%

Question 6

4 Compensatory mechanisms

Answer 6

1. SNS
2. Neurohormonal
3. ADH
4. Proinflammatory cytokines

Question 7

Manifestations

Answer 7

1. Pulmonary edema - increased RR, decreased SpO2 & PaO2, respiratory acidemia
   Orthopnea, dyspnea, use of accessory muscles, cyanosis, cool clammy skin
   Pt. will feel like they’re drowning…panicky

Question 8

Diagnostic studies

Answer 8

H&P, X-ray, ECG, BNP*

Question 9

NYHA classification: Class I

Answer 9

No limitation of physical activity; ordinary physical activity does not cause undue fatigue, palpitation, or SOB

Question 10

NYHA class II (Mild)

Answer 10

Slight limitation of physical activity; comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea

Question 11

NYHA class III (Moderate)

Answer 11

Marked limitation of physical activity; comfortable at rest but less than ordinary activity causes fatigue, palpitation, dyspnea

Question 12

NYHA class IV (severe)

Answer 12

unable to carry out any physical activity w/out discomfort; symptoms of cardiac insufficiency @ rest; discomfort increased with physical activity

Question 13

ACC/AHA stage A

Answer 13

high risk for HF, no symptoms, no structural heart disease

Question 14

ACC/AHA stage B

Answer 14

@ more risk for HF, no symptoms, structural heart disease present

Question 15

ACC/AHA stage C

Answer 15

prior or current symptoms of HF w/ known structural disease

Question 16

ACC/AHA stage D

Answer 16

worst! refractory HF - on maximum management strategies & still have severe symptoms @ rest. End stage