Adhf/ biomarkers Flashcards
How many HF admits per year
1,000,000
35% of patients dead or readmitted within 60 days
Define adhf
A syndrome of congestion and/or low cardiac output
Risk factors for death in adhf
BUN
Blood Pressure
BNP
Nt bnp cutoff for ADHF
Biosite BNP cutoff
340
100
Indications for vasodilators
2a if volume overloaded and not hypotensive
3 types of bnp
Pro Bnp
Nt bnp not biologically active. 5-10 times more than bnp. More affected by renal fxn and age. Cut points is 125 <75, 450 if above 75
Bnp level cutoff is 100
Bnp higher in woman
Class I indications for bnp
Bnp or nt bnp indicated in patients with dyspnea in which contribution of HF is not known.
False negative bnps
Acute rise, obesity, acute mr
False positives:pe, Pulm Htn, acs
Groups in which bnp useful
ADHF, acute dyspnea, chronic HF, diastolic HF.
Do not use for screening.
How do you screen for stage b in stage a patients
Just physical exam. If cad should get echo.
Utility of troponin t in HF
Prognostic value even at low levels
3 types of bnp
Pro Bnp
Nt bnp not biologically active. 5-10 times more than bnp. More affected by renal fxn and age. Cut points is 125 <75, 450 if above 75
Bnp level cutoff is 100
Bnp higher in woman
Class I indications for bnp
Bnp or nt bnp indicated in patients with dyspnea in which contribution of HF is not known.
False negative bnps
Acute rise, obesity, acute mr
False positives:pe, Pulm Htn, acs
Groups in which bnp useful
ADHF, acute dyspnea, chronic HF, diastolic HF.
Do not use for screening.
How do you screen for stage b in stage a patients
Just physical exam. If cad should get echo.
Utility of troponin t in HF
Prognostic value even at low levels
3 types of bnp
Pro Bnp
Nt bnp not biologically active. 5-10 times more than bnp. More affected by renal fxn and age. Cut points is 125 <75, 450 if above 75
Bnp level cutoff is 100
Bnp higher in woman
Class I indications for bnp
Bnp or nt bnp indicated in patients with dyspnea in which contribution of HF is not known.
False negative bnps
Acute rise, obesity, acute mr
False positives:pe, Pulm Htn, acs
Groups in which bnp useful
ADHF, acute dyspnea, chronic HF, diastolic HF.
Do not use for screening.
How do you screen for stage b in stage a patients
Just physical exam. If cad should get echo.
Utility of troponin t in HF
Prognostic value even at low levels
Differences between real world and ADHF trials
Older, female, more hfpef, more hypertensive.
Differences in men and women in ADHF
Women are older, more hypertensive and more hfpef
How much of a rise in creatinine is a bad marker
.3 is a poor prognostic factor in ADHF.
What predicts outcomes in ADHF
BUN <115
Creat 2.75
If you dont know what’s going on by the time you leave the neck you are f’d
Yes
Dose trial affect on renal function
No significant difference though slightly higher
No advantage of infusion over bolts
Effects of unload
Weight loss but no improvement in sx.
Class 2a for people not responding to medical therapy.
Ascend HF
No improvement in mortality
No improvement in 30 d
Modest reduction in dyspnea
Optime trial
Iv milrinone versus placebo
48 hours no differences
Goals for hospitalization
Oral therapy for 24 hour No iv drugs for 24 hours Ambulatory Discharge management Disease management
