ADHF Flashcards
What are ADHF progressions?
HFpEF → HFrEF → Pulmonary congestion → RV dysfunction → Systemic congestion
What are symptoms of low output?
- Altered mental status
- Fatigue
- GI symptoms
- Decreased UO
What are the signs of low output?
- Tachycardia
- Hypotension (hypertension)
- Narrow pulse pressure
- Cool extremities
- Pallor
- Cachexia
Cold signs
What are the symptoms of volume overload?
- dyspnea
- orthopnea
- paroxysmal nocturnal dyspnea
- ascites
- gastrointestinal symptoms
What are the signs of volume overload?
Wet
1. Rales
2. JVD
3. Abdominojugular reflux
4. S3 gallop
5. Peripheral edema
How do we test for low output?
- Elevated LFTs and sCr
- Venous O2 <60%
- Elevated serum lactation
- CI <2.2 w/o SVR >1400
How do we test volume overload?
- Negative predictive
- BNP <100, NBNP <300
- Serum Na <130
- PCWP >18
- Elevated ALP, GGT
Recreate the Swan-Ganz Pulmonary artery cateter (PAC)?
What is PCWP? Systemic vascular resistance?
Preload; Afterload
Describe the correlation between CI and PCWP? CI and SVR?
What is the indication for hospitalization of ADHF based on fluid overload?
Weight gain >10 kg
S/s of congestion
What is the indication for hospitalization of ADHF based on low CO?
- extreme fatigue
- Hypotension, narrow pulse pressure
- Cool extremities
What is the indication for hospitalization of ADHF based on organ hypoperfusion?
- Worsening renal or hepatic function
- Altered mental status
What is the indication for hospitalization of ADHF based on CVD and hemodynamic status?
- MI or ischemia
- Arrhythmia
What are the goals of ADHF therapy?
- Relieve symptoms
- Improve hemodynamic stability
- Reduce short-term mortality
- Address precipitating factors
When would you use chronic meds during hospitalization?
Absence of cardiogenic shock or symptomatic hypotension → continue all GDMT for HF
What chronic meds can be used during hospitalization?
- β-Blocker therapy may be temporarily held or dose-reduced if recent initiation or up-titration is responsible for acute decompensation
- Renal dysfunction → temporarily hold ACEi, ARB, ANRI, aldosterone antagonists
- Digoxin should only be discontinued if serum concentrations cannot be safely maintained within the desirable range
What is Subset 1 and how do you treat it?
Warm and dry
What is subset II and how do you treat it?
What is subset III and how do you treat it?
What is subset IV and how do you treat it?
What is normal MAP?
70-110 mmHg
What is normal CO?
4-6 L/min
Using a chart, describe how ADHF drugs affect PCWP, CI, and SVR?
What is the acute treatment for ADHF?
What is the longterm treatment for ADHF?
How do you adjust loop diuretic dose for ADHF patients being admitted vs their home dose?
take 1-2.5 times the amount of their home dose
What are diuretics used for in ADHF?
Increasing PCWP
What are the loops indicated for ADHF?
What are the thiazides indicated for ADHF?
What are VD used ADHF management? Effects?
What are the inotropes used for ADHF? Receptor Affinity and effects?
- Dobutamine
- Milrinone
- Dopamine
Desicrbe the development of ADHF?
Volume overload/low CO → New or worsening signs/symptoms → Medical intervention required
How many people are hospitalized for HF annually?
1 million
Label the type of mechanical support
Intra-aortic balloon pump (IABP)
Label the type of mechanical support
Impella percutaneous ventricular assist device (VAD)
Label the type of mechanical support
TandemHeart device
Label the type of mechanical support
CentriMag VAD
What is the purpose of a durable MCS? What medications are used?
- Capable of providing up to 10 L/min of CO
- Chronic antithrombotic regimen that balances the risk of device thrombosis and bleeding
Warfarin and antiplatelets
How do prepare hospital discharge?
- IV → PO
- GDMT is stable & IV inotropes/vasodilators have been discontinued for at least 24 hours
- Comorbid conditions have been addressed, to include anemia
- Discussions of palliative/hospice care
What are the steps of transition of care?
- Counsel patients and caregivers
- Appropriate follow-up should be scheduled
- Consider referral to a formal disease management program
When is it appropriate to follow up with a patient?
- Appointment at 7-10 days post discharge
- Nurse visit or phone call at 3 days for select patients (telehealth)
- Pertinent follow-up labs
What should you counsel patients and caregivers on?
- Changes to GDMT medication regimen
- Dietary sodium restriction and education
- Monitoring body weight daily
- Parameters for when to titrate diuretics
- Smoking cessation (counseling, cessation aids prescribed)
