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Cardiology > Chf > Flashcards

Chf Flashcards

0
Q

Acei

Hope study

A 
Cad
OCD
Stroke
DM with another risk factor 
DM with smoking or micro albuminuria
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1
Q

Early satiety is a sign of

A

Right heart failure

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2
Q

Beta blockers

A

People with prior mi
Reduce mortality
Prevent recurrent mi
Prevent CHF

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3
Q

CHF increase mortality

A

With elevated JVD and S3

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4
Q

Bnp

A

Not for routine screening
> 500 high PPV
<100 high negative predictive valuey
Obesity low bnp

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5
Q

Peak VO2

A

Less than 14 is tranplant candidate
Betablockers reduce VO2 but increase survival
Breathing reserve normal value is 30%

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6
Q

Myocardial biopsy

A

Rapidly worsening CHF
Amyloidodis
Malignant arrhythmias if you suspect sarcoidosis or giant cell myocarditis

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7
Q

CHF

A

Do not routinely combine acei and ARB

Betablockers for asptomatic patients with low EF

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8
Q

Coreg

A

Dose dependent effect
Max benifit only with 25 mg bid
Max all meds

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9
Q

Aldosterone in CHF

A

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

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10
Q

Hydralazine/ nitro in CHF

A

A heft trial
Class 1-4 in blacks
In non blacks who has symptoms despite max meds

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11
Q

Diuretics

A

Failure usually due to non compliance
Renal failure
Low cardiac out out
Loop diuretics are better

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12
Q

Loop diuretics

A

Ethycrinic acid no sulfa

Bumex and torsemide are better when lasix fails and in right heart failure

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13
Q

Dig

A

Keep level below 1

No survival benifit in CHF only symptom

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14
Q

CHF adjuvant

A

Pneumonia vaccine
Flu vaccine
Sleep apnea
Ssri better than tricyclics

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15
Q

Heart failure with normal EF

A 
Elderly females
HTN 
DM
Obesity
Cad no previous mi
Survival same as with CHF with reduced EF
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16
Q

Bnp

A

High in both types of CHF

30% reduction necessary before DC

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17
Q

Echo

A

Mitral flow do valsalva

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18
Q

CHF with pedal edema and dyspnea is diastolic CHF

A

Hfpef no treatment works

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19
Q

CHF rehospitaluzation

A

Death usually in one year

20
Q

Aldactone dose

A

Start 50 mg

21
Q

Cold and dry use ionotrophs

A

Cold and wet use nipride and nitro

Avoid lasix it may drop your EF

22
Q

CHF

A

Hypoxia is rare

23
Q

MR surgery

A

Do not fix if the LV is dilated

24
Q

Indications of transplant

A

Intractable CHF
Uncontrolled angina
Uncontrollable VT

25
Q

People with low EF

A

Surgery is better than medical therapy in one vessel, Two vessel and three vessel disease

26
Q

Stitch trial

A

Viability is useless
Remodeling useless
Lima is needed for survival benifit

27
Q

Gorlin formula

A

Is not accurate in low EF so recheck the valve area with dibutamine

28
Q

Regurgitant lesions

A

Operate early

Steno tic lesion do poorly with anesthesia

29
Q

Lone tricuspid repair

A 
Class 2 severe tr
No class 1
30
Q

Icd primary prevention

A

40 days to implant

31
Q

Transplant prognosis

A

Thrombocytopenia and hypo albuminemia are bad signs
11 year survival 50%
Statins improve survival

32
Q

Side effects

A

Cyclosporine rf HTN gingival hyperplasia

Mycophenolate GI neutropenia

33
Q

Post transplant

A

Weekly biopsies for 4 weeks

Every other week for 2 then taper off

34
Q

Rejection

A 
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
35
Q

Humoral

A

Ivg and plasma pheresis

36
Q

Post transplant cad

A

No angina

37
Q

Infection

A

Cmv
Fungal
Pcp prophylaxis

38
Q

Adenosine

A

Effect is unpredictable in transplant patients

39
Q

Breathing reserve

A

30 is normal

35 and above is bad

40
Q

Transplant

A 
Vt VF mean rejection 
Svt humoral rejection 
RBBB due to biopsies 
Heart block
Sinus tachy at the base line
41
Q

Heart mate

A

Continuous flow is better than pulse

42
Q

Transplant RV functions

A

RV stroke work index >300

Cvp<4 wood units

43
Q

Transplant

A

Statins
Statins
Statins

44
Q

Transplant renal insufficiency

A

Try

Basiliximab as a bridge

45
Q

Prevalence 1-2% 40-59 years

12% older than 80

A

20% new cases a year

46
Q

Statins no benifit in CHF

A

Corona study

47
Q

Dibutamine

A

23% people treated may develop eosinophilia myocarditis

48
Q

CHF

A

Avoid nonsteroidals

Cardiology (18 decks)

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