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Therapeutics I > ADHF > Flashcards

ADHF Flashcards

1
Q

What are ADHF progressions?

A

HFpEF → HFrEF → Pulmonary congestion → RV dysfunction → Systemic congestion

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2
Q

What are symptoms of low output?

A
  1. Altered mental status
  2. Fatigue
  3. GI symptoms
  4. Decreased UO
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3
Q

What are the signs of low output?

A
  1. Tachycardia
  2. Hypotension (hypertension)
  3. Narrow pulse pressure
  4. Cool extremities
  5. Pallor
  6. Cachexia

Cold signs

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4
Q

What are the symptoms of volume overload?

A
  1. dyspnea
  2. orthopnea
  3. paroxysmal nocturnal dyspnea
  4. ascites
  5. gastrointestinal symptoms
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5
Q

What are the signs of volume overload?

A

Wet
1. Rales
2. JVD
3. Abdominojugular reflux
4. S3 gallop
5. Peripheral edema

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6
Q

How do we test for low output?

A
  1. Elevated LFTs and sCr
  2. Venous O2 <60%
  3. Elevated serum lactation
  4. CI <2.2 w/o SVR >1400
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7
Q

How do we test volume overload?

A
  1. Negative predictive
  2. BNP <100, NBNP <300
  3. Serum Na <130
  4. PCWP >18
  5. Elevated ALP, GGT
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8
Q

Recreate the Swan-Ganz Pulmonary artery cateter (PAC)?

A
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9
Q

What is PCWP? Systemic vascular resistance?

A

Preload; Afterload

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10
Q

Describe the correlation between CI and PCWP? CI and SVR?

A
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11
Q

What is the indication for hospitalization of ADHF based on fluid overload?

A

Weight gain >10 kg
S/s of congestion

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12
Q

What is the indication for hospitalization of ADHF based on low CO?

A
  1. extreme fatigue
  2. Hypotension, narrow pulse pressure
  3. Cool extremities
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13
Q

What is the indication for hospitalization of ADHF based on organ hypoperfusion?

A
  1. Worsening renal or hepatic function
  2. Altered mental status
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14
Q

What is the indication for hospitalization of ADHF based on CVD and hemodynamic status?

A
  1. MI or ischemia
  2. Arrhythmia
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15
Q

What are the goals of ADHF therapy?

A
  1. Relieve symptoms
  2. Improve hemodynamic stability
  3. Reduce short-term mortality
  4. Address precipitating factors
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16
Q

When would you use chronic meds during hospitalization?

A

Absence of cardiogenic shock or symptomatic hypotension → continue all GDMT for HF

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17
Q

What chronic meds can be used during hospitalization?

A
  1. β-Blocker therapy may be temporarily held or dose-reduced if recent initiation or up-titration is responsible for acute decompensation
  2. Renal dysfunction → temporarily hold ACEi, ARB, ANRI, aldosterone antagonists
  3. Digoxin should only be discontinued if serum concentrations cannot be safely maintained within the desirable range
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18
Q

What is Subset 1 and how do you treat it?

A

Warm and dry

19
Q

What is subset II and how do you treat it?

A
20
Q

What is subset III and how do you treat it?

A
21
Q

What is subset IV and how do you treat it?

A
22
Q

What is normal MAP?

A

70-110 mmHg

23
Q

What is normal CO?

A

4-6 L/min

24
Q

Using a chart, describe how ADHF drugs affect PCWP, CI, and SVR?

A
25
Q

What is the acute treatment for ADHF?

A
26
Q

What is the longterm treatment for ADHF?

A
27
Q

How do you adjust loop diuretic dose for ADHF patients being admitted vs their home dose?

A

take 1-2.5 times the amount of their home dose

28
Q

What are diuretics used for in ADHF?

A

Increasing PCWP

29
Q

What are the loops indicated for ADHF?

A
30
Q

What are the thiazides indicated for ADHF?

A
31
Q

What are VD used ADHF management? Effects?

A
32
Q

What are the inotropes used for ADHF? Receptor Affinity and effects?

A
  1. Dobutamine
  2. Milrinone
  3. Dopamine
33
Q

Desicrbe the development of ADHF?

A

Volume overload/low CO → New or worsening signs/symptoms → Medical intervention required

33
Q

How many people are hospitalized for HF annually?

A

1 million

34
Q

Label the type of mechanical support

A

Intra-aortic balloon pump (IABP)

35
Q

Label the type of mechanical support

A

Impella percutaneous ventricular assist device (VAD)

36
Q

Label the type of mechanical support

A

TandemHeart device

37
Q

Label the type of mechanical support

A

CentriMag VAD

38
Q

What is the purpose of a durable MCS? What medications are used?

A
  1. Capable of providing up to 10 L/min of CO
  2. Chronic antithrombotic regimen that balances the risk of device thrombosis and bleeding

Warfarin and antiplatelets

39
Q

How do prepare hospital discharge?

A
  1. IV → PO
  2. GDMT is stable & IV inotropes/vasodilators have been discontinued for at least 24 hours
  3. Comorbid conditions have been addressed, to include anemia
  4. Discussions of palliative/hospice care
40
Q

What are the steps of transition of care?

A
  1. Counsel patients and caregivers
  2. Appropriate follow-up should be scheduled
  3. Consider referral to a formal disease management program
41
Q

When is it appropriate to follow up with a patient?

A
  1. Appointment at 7-10 days post discharge
  2. Nurse visit or phone call at 3 days for select patients (telehealth)
  3. Pertinent follow-up labs
42
Q

What should you counsel patients and caregivers on?

A
  1. Changes to GDMT medication regimen
  2. Dietary sodium restriction and education
  3. Monitoring body weight daily
  4. Parameters for when to titrate diuretics
  5. Smoking cessation (counseling, cessation aids prescribed)

Therapeutics I (32 decks)

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