Acute Heart Failure Flashcards
Low perfusion at rest =
cold
in Cold and Wet, diuresis will improve
cardiac output
ionotropic drugs if
cold and dry
cold and wet and normal SVR
most patients iwith acute decomp HF fall into this category
wet and warm
impact on cardiac oxygen consumption milrinone
not significant
risks of increased calcium with ionotropes
arrhythmias
limitations of nitroprusside
cynaide toxicity -nausea, weird (if low hepatic perfusion)
accumulation of thiocynate (esp if impaired renal fxn)
diuresis not possible if
renal perfusion impaired
considered a inodilator because ionotrope and vasodilator (cAMP changes lead to relaxation)
milrinone
diuretic side effects
electrolyte abnml
hypotension
gout exacerbation
hearing loss
Digoxin toxicity
renal insuf
muscle cramps (if too rapid)
impact of hypervolemia on CVP
increases CVP
healthy perfusion at rest =
warm
warm vs cold
cardiac index
cardiac index >2.2 = warm
side effects milrinone
hypotension
arrhythmia
tachycardia
congestion at rest =
wet
challenges of diuretics
braking - long term tolerance of natriretic response
rebound may lead to Na retention
long term tolerance due to tubular hypertrophy
Cl levels cold/wet/dry/warm
Warm/Dry - Cl normal
Warm/Wet - Cl normal
Cold Dry - Cl decreased
Cold/wet - Cl decreased
impact on mortality, diuretics
no improvement
therapuetic effect/mechanism Levosimendan
Troponin c to increase Ca sensitivity
Phosphodiesterase III inhibitor
Decreaseases LVEDP, afterload
increases stroke volume
____ vein direct measure of right atrium
right internal jugular
evidence of low perfusion
narrow pulse p
sleepy
low serum Na
Cool extremities
hypotension with ACE
renal dysfxn
requirements for iontrope use
Advance systolic HF
Low output syndrome
hypotension
Vasodilators inffective/contraindicated
Fluid overload + unresponsive to diuretics (or renal failure)
Cold and dry requires _____
cathetar placement to evaluate filling prossure
goal of therapy > wet and warm
Decrease filling pressures (LVEDP, PCWP)
diuretics with improved bioavailability and absorption
Butmetanide
torsemide
produced in atria and ventricles in response to stretch (more prognostic than diagnostic)
Brian natriuretic peptide Nt-pro-BNP
balanced vasodilator
nitroprusside
in DA, afterload increases due to impact on
a receptors
WET
PCWP
RA Pressure
Wet
PCWP > 18
or
RA Pressure >8
no congestion at rest =
dry
ACE inhibitors target
afterload
therapies besides placebo for wet and warm
none
impact of alcohol
impaired contractility
tachycardia decreases ____ time
diastolic filling time
signs/symptoms of congestions
orthopnea/PND
JVD
Ascites
edema
Rales
Dry
PCWP
RA pressure
Dry
PCWP
RA Pressure >8
wet and warm therapy
IV DIeuretics
posible vasdoilators
when to consider PA cath
evalulation of PT for VAD or transplant
Cardiogenic shock
decompensation w/uncertain hemodynamic profile
apparent inotrope dependence or refractory symptoms
uncertain
hypotension or worsening renal fxn with empiric therapy
P2 suggestss
RV volume or pressure overload
at higher doses, DA…
tachycardia without increased ionotropy
mechanism adn effect dobutamine
B1 agonist with weak B2
contractility and mild vasodilator
measures left atrial pressure from venous side
healthy 12-15
wedge pressure
CBC testing of heart failure
anemia or hemoconcentration