Adhf/ biomarkers

Question 1

How many HF admits per year

Answer 1

1,000,000

35% of patients dead or readmitted within 60 days

Question 2

Define adhf

Answer 2

A syndrome of congestion and/or low cardiac output

Question 3

Risk factors for death in adhf

Answer 3

BUN
Blood Pressure
BNP

Question 4

Nt bnp cutoff for ADHF

Biosite BNP cutoff

Answer 4

340

100

Question 5

Indications for vasodilators

Answer 5

2a if volume overloaded and not hypotensive

Question 6

3 types of bnp

Answer 6

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

Question 7

Class I indications for bnp

Answer 7

Bnp or nt bnp indicated in patients with dyspnea in which contribution of HF is not known.

Question 8

False negative bnps

Answer 8

Acute rise, obesity, acute mr

False positives:pe, Pulm Htn, acs

Question 9

Groups in which bnp useful

Answer 9

ADHF, acute dyspnea, chronic HF, diastolic HF.

Do not use for screening.

Question 10

How do you screen for stage b in stage a patients

Answer 10

Just physical exam. If cad should get echo.

Question 11

Utility of troponin t in HF

Answer 11

Prognostic value even at low levels

Question 12

3 types of bnp

Answer 12

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

Question 13

Class I indications for bnp

Answer 13

Bnp or nt bnp indicated in patients with dyspnea in which contribution of HF is not known.

Question 14

False negative bnps

Answer 14

Acute rise, obesity, acute mr

False positives:pe, Pulm Htn, acs

Question 15

Groups in which bnp useful

Answer 15

ADHF, acute dyspnea, chronic HF, diastolic HF.

Do not use for screening.

Question 16

How do you screen for stage b in stage a patients

Answer 16

Just physical exam. If cad should get echo.

Question 17

Utility of troponin t in HF

Answer 17

Prognostic value even at low levels

Question 18

3 types of bnp

Answer 18

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

Question 19

Class I indications for bnp

Answer 19

Bnp or nt bnp indicated in patients with dyspnea in which contribution of HF is not known.

Question 20

False negative bnps

Answer 20

Acute rise, obesity, acute mr

False positives:pe, Pulm Htn, acs

Question 21

Groups in which bnp useful

Answer 21

ADHF, acute dyspnea, chronic HF, diastolic HF.

Do not use for screening.

Question 22

How do you screen for stage b in stage a patients

Answer 22

Just physical exam. If cad should get echo.

Question 23

Utility of troponin t in HF

Answer 23

Prognostic value even at low levels

Question 24

Differences between real world and ADHF trials

Answer 24

Older, female, more hfpef, more hypertensive.

Question 25

Differences in men and women in ADHF

Answer 25

Women are older, more hypertensive and more hfpef

Question 26

How much of a rise in creatinine is a bad marker

Answer 26

.3 is a poor prognostic factor in ADHF.

Question 27

What predicts outcomes in ADHF

Answer 27

BUN <115

Creat 2.75

Question 28

If you dont know what’s going on by the time you leave the neck you are f’d

Answer 28

Yes

Question 29

Dose trial affect on renal function

Answer 29

No significant difference though slightly higher

No advantage of infusion over bolts

Question 30

Effects of unload

Answer 30

Weight loss but no improvement in sx.

Class 2a for people not responding to medical therapy.

Question 31

Ascend HF

Answer 31

No improvement in mortality
No improvement in 30 d
Modest reduction in dyspnea

Question 32

Optime trial

Answer 32

Iv milrinone versus placebo

48 hours no differences

Question 33

Goals for hospitalization

Answer 33

Oral therapy for 24 hour 
No iv drugs for 24 hours
Ambulatory 
Discharge management 
Disease management