acute decompensated HF

Question 1

3 things stroke volume is a function of

Answer 1

1. preload
2. afterload
3. contactility

Question 2

what happens in decompensation

Answer 2

tenuous balance with chronic LV changes, then something happens

1. incr. preload
2. incr. afterload
3. dec. contactipn

= RAPID onset of Sx of HF

Question 3

what happens to lungs to case edema

Answer 3

1. LV has high fillingP and backs up

2. RV tries to cope by pushing forward even more

Question 4

signs of HF

Answer 4

1. cough
2. SOB
3. edema
4. elevated JVP

Question 5

4 patient profiles

Answer 5

1. dry and warm - healthy
2. dry and cold (low perf)
   - sick, but compensated
3. wet and warm (congested)
   - most common
4. wet and cold (low perf and congestion)
   - bad shape

Question 6

2 helpful tests

Answer 6

1. ECG
2. labs
   - renal, leyte, CBC, troponin
   - brain naturetic peptide (BNP)

Question 7

what is BNP

Answer 7

released when ventricles are stretched

Question 8

3 levels for BNP

Answer 8

500 - HF likely

** not useful if HF is obvious

Question 9

3 tests in acute decomp. HF

Answer 9

1. CXR -high yield
2. echo - only if not done recently
3. heart cath - active ischemia

Question 10

5 things to do to help stabilize

Answer 10

1. elevate bed
2. frequent vitals
3. O2 - monitor sats
4. IV access
5. PPV may help

Question 11

5 durgs that improve hemodynamics and make ppl feel better

Answer 11

1. diuretics
2. morphine
3. digoxin
4. vasodilators
5. ionotropes

Question 12

4 pearls for loop diuretics

Answer 12

1. IV furosomide best
2. high dose can worsen renal funct
3. resistance can occur
4. ototoxic at high doses

Question 13

how do diuretics help

Answer 13

reduce end diastolic pressure

Question 14

how does morphine help

Answer 14

1. pulmonary veno-dilator - reduces preload
2. reduces SNS activation
3. reduces dyspneaic sensation

Question 15

pearls for digoxin

Answer 15

• incr. CA in myocyte
• weak effect in contraction
• incr. vagal tone and slows HR
• NARROW therapeutic index

Question 16

what do vasodialtorsdo

Answer 16

nirto

- reduce after and pre-load

Question 17

what are ionotropes (2)

Answer 17

1. B agonists
2. PDEis - milronone
   - incr. contractility and less pre and afterload

Question 18

**when not to use ionotrope

Answer 18

perfuse person

Question 19

3 pearls to optimize med therp

Answer 19

1. initiate ACE and BB for LV dysfunciton when Pt is compensated
2. BP, renal, lytes should be monitored when titrating ACEi
3. start BB only when PT is stable and compensated

Question 20

3 meds to aviod in decomp. HF

Answer 20

1. CCBs - negative ionotrope effects
2. anti-arryhtmics
3. NSAIDS - promote HT, Na retention