Adhf/ biomarkers Flashcards

1
Q

How many HF admits per year

A

1,000,000

35% of patients dead or readmitted within 60 days

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2
Q

Define adhf

A

A syndrome of congestion and/or low cardiac output

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3
Q

Risk factors for death in adhf

A

BUN
Blood Pressure
BNP

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4
Q

Nt bnp cutoff for ADHF

Biosite BNP cutoff

A

340

100

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5
Q

Indications for vasodilators

A

2a if volume overloaded and not hypotensive

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6
Q

3 types of bnp

A

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

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7
Q

Class I indications for bnp

A

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

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8
Q

False negative bnps

A

Acute rise, obesity, acute mr

False positives:pe, Pulm Htn, acs

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9
Q

Groups in which bnp useful

A

ADHF, acute dyspnea, chronic HF, diastolic HF.

Do not use for screening.

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10
Q

How do you screen for stage b in stage a patients

A

Just physical exam. If cad should get echo.

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11
Q

Utility of troponin t in HF

A

Prognostic value even at low levels

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12
Q

3 types of bnp

A

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

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13
Q

Class I indications for bnp

A

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

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14
Q

False negative bnps

A

Acute rise, obesity, acute mr

False positives:pe, Pulm Htn, acs

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15
Q

Groups in which bnp useful

A

ADHF, acute dyspnea, chronic HF, diastolic HF.

Do not use for screening.

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16
Q

How do you screen for stage b in stage a patients

A

Just physical exam. If cad should get echo.

17
Q

Utility of troponin t in HF

A

Prognostic value even at low levels

18
Q

3 types of bnp

A

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

19
Q

Class I indications for bnp

A

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

20
Q

False negative bnps

A

Acute rise, obesity, acute mr

False positives:pe, Pulm Htn, acs

21
Q

Groups in which bnp useful

A

ADHF, acute dyspnea, chronic HF, diastolic HF.

Do not use for screening.

22
Q

How do you screen for stage b in stage a patients

A

Just physical exam. If cad should get echo.

23
Q

Utility of troponin t in HF

A

Prognostic value even at low levels

24
Q

Differences between real world and ADHF trials

A

Older, female, more hfpef, more hypertensive.

25
Differences in men and women in ADHF
Women are older, more hypertensive and more hfpef
26
How much of a rise in creatinine is a bad marker
.3 is a poor prognostic factor in ADHF.
27
What predicts outcomes in ADHF
BUN <115 | Creat 2.75
28
If you dont know what's going on by the time you leave the neck you are f'd
Yes
29
Dose trial affect on renal function
No significant difference though slightly higher | No advantage of infusion over bolts
30
Effects of unload
Weight loss but no improvement in sx. | Class 2a for people not responding to medical therapy.
31
Ascend HF
No improvement in mortality No improvement in 30 d Modest reduction in dyspnea
32
Optime trial
Iv milrinone versus placebo | 48 hours no differences
33
Goals for hospitalization
``` Oral therapy for 24 hour No iv drugs for 24 hours Ambulatory Discharge management Disease management ```