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Cardiovascular > Acute Heart Failure > Flashcards

Acute Heart Failure Flashcards

1
Q

Low perfusion at rest =

A

cold

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1
Q

in Cold and Wet, diuresis will improve

A

cardiac output

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1
Q

ionotropic drugs if

A

cold and dry

cold and wet and normal SVR

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1
Q

most patients iwith acute decomp HF fall into this category

A

wet and warm

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2
Q

impact on cardiac oxygen consumption milrinone

A

not significant

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4
Q

risks of increased calcium with ionotropes

A

arrhythmias

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5
Q

limitations of nitroprusside

A

cynaide toxicity -nausea, weird (if low hepatic perfusion)

accumulation of thiocynate (esp if impaired renal fxn)

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6
Q

diuresis not possible if

A

renal perfusion impaired

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7
Q

considered a inodilator because ionotrope and vasodilator (cAMP changes lead to relaxation)

A

milrinone

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7
Q

diuretic side effects

A

electrolyte abnml

hypotension

gout exacerbation

hearing loss

Digoxin toxicity

renal insuf

muscle cramps (if too rapid)

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9
Q

impact of hypervolemia on CVP

A

increases CVP

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9
Q

healthy perfusion at rest =

A

warm

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9
Q

warm vs cold

cardiac index

A

cardiac index >2.2 = warm

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9
Q

side effects milrinone

A

hypotension

arrhythmia

tachycardia

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10
Q

congestion at rest =

A

wet

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11
Q

challenges of diuretics

A

braking - long term tolerance of natriretic response

rebound may lead to Na retention

long term tolerance due to tubular hypertrophy

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12
Q

Cl levels cold/wet/dry/warm

A

Warm/Dry - Cl normal

Warm/Wet - Cl normal

Cold Dry - Cl decreased

Cold/wet - Cl decreased

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12
Q

impact on mortality, diuretics

A

no improvement

14
Q

therapuetic effect/mechanism Levosimendan

A

Troponin c to increase Ca sensitivity

Phosphodiesterase III inhibitor

Decreaseases LVEDP, afterload

increases stroke volume

15
Q

____ vein direct measure of right atrium

A

right internal jugular

16
Q

evidence of low perfusion

A

narrow pulse p

sleepy

low serum Na

Cool extremities

hypotension with ACE

renal dysfxn

17
Q

requirements for iontrope use

A

Advance systolic HF

Low output syndrome

hypotension

Vasodilators inffective/contraindicated

Fluid overload + unresponsive to diuretics (or renal failure)

18
Q

Cold and dry requires _____

A

cathetar placement to evaluate filling prossure

19
Q

goal of therapy > wet and warm

A

Decrease filling pressures (LVEDP, PCWP)

20
Q

diuretics with improved bioavailability and absorption

A

Butmetanide

torsemide

22
Q

produced in atria and ventricles in response to stretch (more prognostic than diagnostic)

A

Brian natriuretic peptide Nt-pro-BNP

23
Q

balanced vasodilator

A

nitroprusside

24
Q

in DA, afterload increases due to impact on

A

a receptors

25
Q

WET

PCWP

RA Pressure

A

Wet

PCWP > 18

or

RA Pressure >8

26
Q

no congestion at rest =

A

dry

28
Q

ACE inhibitors target

A

afterload

29
Q

therapies besides placebo for wet and warm

A

none

30
Q

impact of alcohol

A

impaired contractility

31
Q

tachycardia decreases ____ time

A

diastolic filling time

32
Q

signs/symptoms of congestions

A

orthopnea/PND

JVD

Ascites

edema

Rales

33
Q

Dry
PCWP
RA pressure

A

Dry

PCWP

RA Pressure >8

34
Q

wet and warm therapy

A

IV DIeuretics

posible vasdoilators

36
Q

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

A

uncertain

hypotension or worsening renal fxn with empiric therapy

37
Q

P2 suggestss

A

RV volume or pressure overload

38
Q

at higher doses, DA…

A

tachycardia without increased ionotropy

40
Q

mechanism adn effect dobutamine

A

B1 agonist with weak B2

contractility and mild vasodilator

41
Q

measures left atrial pressure from venous side

healthy 12-15

A

wedge pressure

42
Q

CBC testing of heart failure

A

anemia or hemoconcentration

Cardiovascular (39 decks)

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