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Foundations II (Cholley) > CHF > Flashcards

CHF Flashcards

1
Q

What causes serum Na abnormalities?

A

Changes in TBW

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2
Q

Rapid shifts in osmolarity lead to what?

A

Change in cell volume

- Can induce seizures

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3
Q

ADH is secreted in response to what?

A
  • Hyperosmolarity
  • ↓effective arterial volume
  • Angiotensin II
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4
Q

Aldosterone

A

Regulates total body Na & therefore volume

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5
Q

Aldosterone is secreted in response to what?

A

Hypovolemia via renin & angiotensin II

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6
Q

What does ADH cause?

A

Insertion of aquaporin channels into collecting ducts –> H2O reabsorption

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7
Q

Define CHF

A

Inability of the heart to pump in proportion to the metabolic demands of the body

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8
Q

What does CHF lead to?

A

Usually a hypervolemic state

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9
Q

What is the most common cause of hospitalization for pts aged 65 & older?

A

CHF

- Primarily a disease of aging

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10
Q

CHF risk factors

A 
Obesity
Obstructive sleep apnea
Smoking
Pregnancy
Infection
Diabetes
Physical inactivity
Renal insufficiency
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11
Q

What are the 4 major determinants of CO?

A
  1. Contractility
  2. Preload
  3. Afterload
  4. HR
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12
Q

What can increase afterload?

A
  • HTN
  • AS
  • Coarctation of aorta
  • Atherosclerosis
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13
Q

Systolic HF

A
  • LV EF is reduced

- Results in eccentric remodeling

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14
Q

Diastolic HF

A
  • LV systolic fxn is typically preserved
  • Altered ventricular compliance –> high filling pressure
  • Results in concentric remodeling
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15
Q

What is the #1 cause of systolic HF?

A

Ischemia

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16
Q

Systolic HF

A

CAD w/ MI

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17
Q

What is the #2 cause of systolic HF?

A

HTN

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18
Q

Diastolic HF

A

Abnormal diastolic relaxation or ventricle filling

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19
Q

Cardiomyopathies

A

Dilated & hypertrophic

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20
Q

Causes of cardiomyopathies

A
  • Ischemic vs non-ischemic
  • Genetic/familial
  • HTN
  • Hemochromatosis
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21
Q

Most common cause of R sided HF is what?

A

L sided HF

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22
Q

Other causes of RV failure

A
  • Pulmonary embolism
  • Endocarditis
  • Toxic substances & illicit drugs
  • Myocarditis
  • COPD
  • Pulmonary HTN
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23
Q

Acute HF causes

A
  • MI
  • Rupture of intraventricular septum
  • Acute valvular incompetence
  • Pulmonary embolism
  • Cardiac tamponade
  • Fulminant myocarditis

*Require immediate dx & tx

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24
Q

What causes high output HF?

A
  • Pregnancy
  • Anemia
  • Thyrotoxicosis
  • Beriberi
  • Paget’s disease
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25
Q

Stage A

A
  • At high risk w/o structural disease or sx

- Ex. HTN

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26
Q

Stage B

A

Structural disease but w/out sx

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27
Q

Stage C

A

Structural heart disease w/ prior or current sx

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28
Q

Stage D

A

Refractory HF, requiring interventions

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29
Q

NYHA classification

A
  • I: Asymptomatic
  • II: Sx w/ moderate exertion
  • III: Sx w/ mild exertion
  • IV: Sx at rest
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30
Q

LV failure signs & sx

A

Low CO & elevated venous pressure:

  • Fatigue
  • Dyspnea
  • Weight gain
  • Crackles
  • Elevated jugular venous pressure
  • Edema
  • Paroxysmal nocturnal dyspnea
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31
Q

What is the #1 sx seen in RV failure?

A

Edema

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32
Q

What is hepatojugular reflux associated w/?

A

Both L-sided & R-sided HF

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33
Q

Hepatojugular reflux procedure

A
  1. Firm, yet gentle, compression applied to RUQ for 1 min
  2. Advise pt to breath normally
  3. Observe neck vv
  4. JVP should rise or fall 4cm after pressure released
34
Q

What is specific on PE for CHF in middle-aged & older adults?

A

S3 gallop

35
Q

What may be heard in diastolic failure & what does it imply?

A

S4 gallop

- Implies noncompliant ventricle

36
Q

Dx studies

A
  • CBC (anemia)
  • CMP
  • BNP
  • Thyroid fxn
  • Iron studies
  • EKG (acute vs chronic changes)
  • Pulse oximetry
  • ABG
  • PEFR
  • CXR (cardiomegaly)
  • Echo
  • Cardiac cath
37
Q

BNP (definition & what does it reflect?)

A
  • Hormone released from heart in response to ventricular volume expansion & pressure overload
  • May reflect severity of CHF
38
Q

BNP < 100

A

CHF can be excluded

39
Q

BNP 100-400

A

Inconclusive

40
Q

BNP > 400

A

Consistent w/ CHF

41
Q

EKG, acute vs chronic changes

A
  • Acute (AMI, dysrhythmia, pulmonary embolism)
  • Chronic (LVH, old MI)
  • 25% have conduction abnormality (most common = LBBB)
42
Q

Pulse oximetry

A

Noninvasive estimate of O2 saturation

- optimal = > 92%

43
Q

ABG

A

Mild hypoxia, hypocarbia, & respiratory alkalosis occur early in CHF

44
Q

What implies critical CHF?

A

Worsening PaO2 & metabolic acidosis

45
Q

What helps distinguish early CHF from COPD?

A

Peak Expiratory Flow Rate (PEFR)

  • > 150 = acute CHF
  • < 150 = COPD
46
Q

A normal size heart w/ CHF on CXR may suggest what?

A

acute MI, constrictive pericarditis, or mitral stenosis

47
Q

Echo

A

Most useful tool for evaluating:

  • Etiology of CHF
  • Extent of CHF (EF)
48
Q

Cardiac catherization

A

Direct measurement of ventricular diastolic pressure

  • Demonstrates impaired relaxation & filling
  • Ruleout CAD & valvular heart disease
49
Q

Goals of tx

A
  1. improve QOL
  2. improve cardiac fxn when possible
  3. reduce risk of death
50
Q

Optimal therapy

A

Combination of:

  • Multiple meds & non-drug tx
  • Lifestyle changes
  • Electrophysiologic & surgical therapies
51
Q

Lifestyle changes

A
  • carbs & caloric restriction
  • caloric supplementation
  • restriction of Na & fluid intake
  • support stockings
  • multivitamin
  • exercise
  • smoking cessation
  • limit alcohol
  • avoid NSAIDS
  • CPAP
52
Q

What vaccines should pts w/ HF receive?

A
  • Pneumococcal

- Influenza

53
Q

What is the initial pharmacologic tx in MOST pts w/ sx?

A

Combo of diuretic & ACE

54
Q

What medication should be avoided?

A

Ca channel blockers

- Can worsen CHF w/ chronic use

55
Q

Beta blockers

A

Protect from SNS overstimulation
- Should be avoided in:
Heart block, bradycardia, severe bronchospasm, & dyspnea at rest

56
Q

Diuretics

A
  • Decrease preload
  • Provide sx relief
  • Frequent monitoring of renal fxn, dehydration, & electrolytes needed
57
Q

Loop diuretics

A
  • Useful in patients w/ more severe CHF
  • Used IV in acute setting
  • Furosemide produces prompt venodilation & diuresis
58
Q

Adverse rxns of loop diuretics

A
  • intravascular volume depletion
  • hypotension
  • hypokalemia (increases digoxin action)
59
Q

When are K+ sparing agents indicated?

A

In pts who have:

  • NYHA class III or IV w/ LV dysfunction OR
  • Had an acute MI & sx of HF & LVEF < 40%
60
Q

Examples of K+ sparing agents

A
  • Spironolactone (Aldactone) 25mg PO qd
  • Triamterene (Dyrenium) 100mg PO bid
  • Amiloride (Midamor) 5-10mg PO qd
61
Q

What is the fxn of K+ sparing agents?

A
  • Prevent remodeling of the heart due to catecholamines
  • Inhibit RAAS system
  • Can be used w/ loop & thiazide
62
Q

Fxn of spironolactone

A

Mediates some of the major effects of the RAAS system:

  • Myocardial remodeling
  • Fibrosis
  • Na retention & K+ loss
  • Should monitor for hyperkalemia
63
Q

What do ACE-I cause?

A

Vascular dilation –> decrease in both preload & afterload

64
Q

What are ACE-I associated w/?

A

Decreased mortality & improved status in those w/ systolic HF

65
Q

How do you prevent hypotension in those taking ACE?

A
  • Initiate at low dose

- Titrate up if tolerated

66
Q

ACE contraindications

A
  • Renal insufficiency
  • Bilateral renal artery stenosis
  • Hyperkalemia
  • Symptomatic hypotension
  • Hx of adverse rxns
67
Q

Fxn of ARBs

A

Block A-II type 1 (AT) receptor (potent vasoconstrictors that may contribute to the impairment of LV fxn)

68
Q

Fxn of Neprilysin (ARNI)

A

Degrades natriuretic peptides

69
Q

Another example of ARNI

A

Sacubitril-valsartan (Entresto)

70
Q

What do beta blockers reduce?

A

Hospitalizations, sudden death, & mortality in CHF

71
Q

Examples of beta blockers

A
  • Carvedilol
  • Metoprolol succinate
  • Bisoprolol
72
Q

Beta blockers precautions

A 
Hypoglycemia
Asthma
Resting limb ischemic pain
Bradycardia
Hypotension
73
Q

Digoxin

A
  • Does not improve survival, but does improve sx & decrease hospitalizations
  • Increases CO
  • Inhibits Na/K/ATPase pump
74
Q

Direct vasodilating drugs (hydralazine, isosorbide)

A

Reduce systemic vascular resistance & venous pressure (afterload)
*Consider in black pts!

75
Q

Nitrates

A
  • Type of vasodilator

- Relieves SOB

76
Q

Example of nitrates

A

Nitroglycerin

- Reduces preload

77
Q

Sodium nitroprusside (Nitropress)

A
  • Potent dilator of arteriolar resistance & venous capacitance
  • Increases CO, decreases ventricular filling pressures
78
Q

Fxn of ICDs

A
  • Monitor HR & rhythm

- Correct arrhythmias

79
Q

Who qualifies for an ICD?

A
  • Pt w/ previous MI & EF < 30%
  • Pt w/ EF < 35% & NYHA II/III
  • Pt whose life expectancy exceeds 1 yr
80
Q

Who qualifies for a biventricular pacemaker?

A

Symptomatic pts w/ NYHA III or IV w/ EF < 35% & QRS > 130 despite max therapy

Foundations II (Cholley) (25 decks)

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