acute decompensated HF Flashcards
1
Q
3 things stroke volume is a function of
A
- preload
- afterload
- contactility
2
Q
what happens in decompensation
A
tenuous balance with chronic LV changes, then something happens
- incr. preload
- incr. afterload
- dec. contactipn
= RAPID onset of Sx of HF
3
Q
what happens to lungs to case edema
A
- LV has high fillingP and backs up
2. RV tries to cope by pushing forward even more
4
Q
signs of HF
A
- cough
- SOB
- edema
- elevated JVP
5
Q
4 patient profiles
A
- dry and warm - healthy
- dry and cold (low perf)
- sick, but compensated - wet and warm (congested)
- most common - wet and cold (low perf and congestion)
- bad shape
6
Q
2 helpful tests
A
- ECG
- labs
- renal, leyte, CBC, troponin
- brain naturetic peptide (BNP)
7
Q
what is BNP
A
released when ventricles are stretched
8
Q
3 levels for BNP
A
500 - HF likely
** not useful if HF is obvious
9
Q
3 tests in acute decomp. HF
A
- CXR -high yield
- echo - only if not done recently
- heart cath - active ischemia
10
Q
5 things to do to help stabilize
A
- elevate bed
- frequent vitals
- O2 - monitor sats
- IV access
- PPV may help
11
Q
5 durgs that improve hemodynamics and make ppl feel better
A
- diuretics
- morphine
- digoxin
- vasodilators
- ionotropes
12
Q
4 pearls for loop diuretics
A
- IV furosomide best
- high dose can worsen renal funct
- resistance can occur
- ototoxic at high doses
13
Q
how do diuretics help
A
reduce end diastolic pressure
14
Q
how does morphine help
A
- pulmonary veno-dilator - reduces preload
- reduces SNS activation
- reduces dyspneaic sensation
15
Q
pearls for digoxin
A
- incr. CA in myocyte
- weak effect in contraction
- incr. vagal tone and slows HR
- NARROW therapeutic index
