CHF

Question 1

What is CHF?

Answer 1

Syndrome of abnormal retention of water and sodium which results in venous congestion
Adversely affecting left atrial pressure and CO

Question 2

What are pathological changes that can cause CHF?

Answer 2

Myocardial contractility
Valve integrity
Preload or afterload of ventricle
HR
Cardiac remodeling

Question 3

Left-sided heart failure

Answer 3

Exertional pulmonary vascular congestion that leads to exertion dyspnea, cough, fatigue, orthopnea, paroxysmal nocturnal, rails, gallops, and exercise intolerance

Question 4

Right-Sided heart failure

Answer 4

Systemic vascular congestion characterized by JVD, hepatic congestion, decreased appetite/nausea, dependent pitting edema

Question 5

Cardiac signs of CHF

Answer 5

Parasternal lift
Enlarged, displaced, or hyper dynamic apical pulse
Diminished S1
S3 gallop
Sometime S4 gallop with diastolic failure

Question 6

Signs & symptoms of CHF

Answer 6

• Pallor, cold, clammy skin
• Nocturia
• Hypotension
• Narrow pulse pressure

Question 7

CHF patients may also have what other conditions?

Answer 7

Anemia, renal insufficiency, hyperkalemia, hyponatremia, elevated liver enzymes

Question 8

Preventative and non pharmacological treatments for CHF

Answer 8

Exercise, low sodium diet, smoking cessation, limit ETOH, and stress reduction

Revascularization, valve replacements, renal denervation, mechanical devices, transplantation

Question 9

Initial therapy for CHF

Answer 9

ACE-I: decrease in left ventricle wall stress and slows remodeling

ARBs if ACE is not tolerated

Question 10

Other therapies of CHF

Answer 10

BB: improve ejection fraction, reduce left ventricular dilation, and reduce incidence of dysrhythmia

Aldosterone Receptor Antagonist: used in combo with ARB and BB in pt with heart failure

Question 11

Diuretics use in CHF treatment

Answer 11

with right sided heart failure fluid retention can be relieved with diuretic

Question 12

When to use CCB in CHF?

Answer 12

Amlodipine in angina or HTN

Question 13

Stage A treatment of CHF

Answer 13

Control risk factors such as HTN, CAD, hyperlipidemia, smoking, ETOH, and diabetes

Question 14

Treatment of stages B,C, and D

Answer 14

• Diuretics
• ACE-I/ARBs
• BB (careful use in pt with BM, asthma, bradydysrhythmias and heart block
• Aldosterone antagonists

Question 15

What 3 BB have been shown effective for CHF pts

Answer 15

Carvedilol
Metoprolol succinate
Bisoprolol