Chf Flashcards
Acei
Hope study
Cad OCD Stroke DM with another risk factor DM with smoking or micro albuminuria
Early satiety is a sign of
Right heart failure
Beta blockers
People with prior mi
Reduce mortality
Prevent recurrent mi
Prevent CHF
CHF increase mortality
With elevated JVD and S3
Bnp
Not for routine screening
> 500 high PPV
<100 high negative predictive valuey
Obesity low bnp
Peak VO2
Less than 14 is tranplant candidate
Betablockers reduce VO2 but increase survival
Breathing reserve normal value is 30%
Myocardial biopsy
Rapidly worsening CHF
Amyloidodis
Malignant arrhythmias if you suspect sarcoidosis or giant cell myocarditis
CHF
Do not routinely combine acei and ARB
Betablockers for asptomatic patients with low EF
Coreg
Dose dependent effect
Max benifit only with 25 mg bid
Max all meds
Aldosterone in CHF
Increased 20 times normal in CHF
Rales study shows benifit
But needs to be on acei first
Eplerinone which is an Aldo blocker in emphasis trial shows improved survival
Hydralazine/ nitro in CHF
A heft trial
Class 1-4 in blacks
In non blacks who has symptoms despite max meds
Diuretics
Failure usually due to non compliance
Renal failure
Low cardiac out out
Loop diuretics are better
Loop diuretics
Ethycrinic acid no sulfa
Bumex and torsemide are better when lasix fails and in right heart failure
Dig
Keep level below 1
No survival benifit in CHF only symptom
CHF adjuvant
Pneumonia vaccine
Flu vaccine
Sleep apnea
Ssri better than tricyclics
Heart failure with normal EF
Elderly females HTN DM Obesity Cad no previous mi Survival same as with CHF with reduced EF
Bnp
High in both types of CHF
30% reduction necessary before DC
Echo
Mitral flow do valsalva
CHF with pedal edema and dyspnea is diastolic CHF
Hfpef no treatment works
CHF rehospitaluzation
Death usually in one year
Aldactone dose
Start 50 mg
Cold and dry use ionotrophs
Cold and wet use nipride and nitro
Avoid lasix it may drop your EF
CHF
Hypoxia is rare
MR surgery
Do not fix if the LV is dilated
Indications of transplant
Intractable CHF
Uncontrolled angina
Uncontrollable VT
People with low EF
Surgery is better than medical therapy in one vessel, Two vessel and three vessel disease
Stitch trial
Viability is useless
Remodeling useless
Lima is needed for survival benifit
Gorlin formula
Is not accurate in low EF so recheck the valve area with dibutamine
Regurgitant lesions
Operate early
Steno tic lesion do poorly with anesthesia
Lone tricuspid repair
Class 2 severe tr No class 1
Icd primary prevention
40 days to implant
Transplant prognosis
Thrombocytopenia and hypo albuminemia are bad signs
11 year survival 50%
Statins improve survival
Side effects
Cyclosporine rf HTN gingival hyperplasia
Mycophenolate GI neutropenia
Post transplant
Weekly biopsies for 4 weeks
Every other week for 2 then taper off
Rejection
Hyper acute Cellular Humoral 0 no infiltrate 1a focal 1b diffuse but sparse 2 one focus 3a multi focal with necrosis 3b diffuse with necrosis 4 severe diffuse hemorrhagic
Humoral
Ivg and plasma pheresis
Post transplant cad
No angina
Infection
Cmv
Fungal
Pcp prophylaxis
Adenosine
Effect is unpredictable in transplant patients
Breathing reserve
30 is normal
35 and above is bad
Transplant
Vt VF mean rejection Svt humoral rejection RBBB due to biopsies Heart block Sinus tachy at the base line
Heart mate
Continuous flow is better than pulse
Transplant RV functions
RV stroke work index >300
Cvp<4 wood units
Transplant
Statins
Statins
Statins
Transplant renal insufficiency
Try
Basiliximab as a bridge
Prevalence 1-2% 40-59 years
12% older than 80
20% new cases a year
Statins no benifit in CHF
Corona study
Dibutamine
23% people treated may develop eosinophilia myocarditis
CHF
Avoid nonsteroidals
