CHF

Question 1

most cases of CHF are caused by

Answer 1

coronary artery dis or HTN

Question 2

tx for new onset heart failure

Answer 2

morphine sulfate (decrease pain/catecholamine and vasodilator)

foruosemide-diuretic and vasodilatory on bronchial vasculature

Question 3

major criteria for CHF

Answer 3

proxysmal nocturnal dyspnea
JVD
rales
cardiomegaly
pulmonary edema
S3 gallop
CVP>16 
circulation time of 25 seconds
hepatojugular reflex
weight loss of 4.5 kg over 5 days of tx

Question 4

CHF-initial blood tests?

Answer 4

CBC (WBC can identify infection induced CHF, anemia)

serum electrolytes (neurohumoral responses to failing heart-water and Na retention, potassium excretion, also meds for chronic heart dis can cause elec abnorm)

renal function tests
hepatic function tests
cardiac enzymes (look for MI as inciting event)

Question 5

gold standard diagnostic modality in the presence of CHF

Answer 5

echocardiography (to look at structural causes, distinguish diastolic or systolic, to look at cardiac ejection fraction)

Question 6

in all cases of acute CHF, initial management is

Answer 6

ABCs FIRST

then loop diuretic, nitrates, morphine sulphate

Question 7

first line therapy in pts with CHF and reduced left ventricular fxn

Answer 7

ACE inhibitors

Question 8

ACE inhibitors are contraindicated in

Answer 8

pregnancy
hypotension
hyperkalemia
bilateral renal artery stenosis
with caution in pts with renal insufficiency