CHF Flashcards
What state does CHF result in
Hypervolemic state
What is CHF
inability of the heart to pump blood in proportion to metabolic demands
-A disease of aging
What is cardiac output of the heart governed by
Preload
After load
Contractile state of myocardium
Heart rate
CO=HRxSV
What happens in systolic HF
LV EF reduced
What happens in diastolic HF
altered ventricular compliance causes high filling pressures
EF not affected
What are the causes of Systolic HF
#1: CAD with MI (ischemia in US) #2: HTN
What are the causes of diastolic HF
Abnormal ventricular filling
What are causes of LV failure
arrhythmia
valve disease
cardiomyopathy
What are causes of RV failure
Left sided HF!
What is the ACC/AHA classification
Class A: high risk but no structural abnormality and no symptoms
Class B: Structural abnormality but asymptomatic
Class C: Structural abnormality with HF Symptoms
Claud D: Need intervention due to refractory HF
What is the NYHA classification
I: Asymptomatic
II: Symptomatic with moderate exercise
III: Symptomatic with minimal exercise
IIII: Symptomatic at rest
What are signs of LV HF
Pulmonary HTN Pulmonary edema Crackles Fatigue Dyspnea Elevated JVD PND
What are signs of RV HF
Hepatomegaly
Peripheral edema
Anasarca
Ascites
What HF is hepatojugular reflux associated with
Both left and right
(looking for 4cm rise or fall
When is S3 seen
With CHF, indicative of fluid sloshing into the dilated ventricles
When is S4 seen
In diastolic failure, when the walls are too stiff to allow filling
What would you get a CBC to check
Anemia (low H&H), which causes a high output failure
What would a CMP reveal
hypo/hyperkalemia
hyponatremia
high BUN/Cr
hight LFT
What is BNP
enzyme released from heart in response to ventricular pressure overload
What are the important BNP levels
<100: NOT CHF
>400: consistent with CHF
What are optimal oxygen sat levels
> 92%
What ABG’s will you see with early CHF
Hypoxia
Hyperventilation
Respiratory ALKalosis
What ABG’s will you see with critical CHF
Worsening CHF
Metabolic alkalosis
What is cardiomegaly
Cardiac silhouette is greater than 1/2 transthoracic diameter
What will you see on CXR in CHF
Cardiomegaly
Kerley B Lines
bilateral hilar infiltrates
What does a normal size heart with CHF indicate
Mitral stenosis
Constrictive pericarditis
AMI
What is the most useful non-invasive diagnostic tool for CHF
Echo
Evaluates Etiology and Extent of HF
What does a cardiac cath provide
Direct measurement of ventricular diastolic pressure
can show impaired relaxation and filling
What does “optimal therapy” require
Combo of:
Multiple meds
TLC
Surgical therapies
What vaccines should HF patients receive
Flu
Pneumococcal
What is initial pharmacologic therapy in HF
combination of diuretic and ACE-I
What drug should be AVOIDED in HF
CCB- can worsen HF
What do diuretics do
Decrease preload in fluid overload patients (make you pee out so you have less fluid that fills the ventricles)
What diuretics are good for outpatient management, though they are not as good as loops
Thiazides
What diuretics are most useful in CHF patients
Loop diuretics
Why is Spironolactone good to add to loop and thiazide
It is an aldosterone antagonist, and aldosterone is usually high in CHF
What must you monitor when taking Spironalactone
Hyperkalemia
What do ACE-I do
reduce both preload and after load
When are ARB’s useful
When patients are unable to take ACE due to angioedema or cough
Who are BB especially useful in
all stable patients with HF!
Hx MI, EF <40% and asymptomatic, stable HF
What are BB known to do
reduce hospitalizations, sudden death, overall mortality in CHF
What drug relieves symptoms but does NOT improve survival
Digoxin (increases CO)
What med should be considered for Af.Am. patients and those who remain symptomatic despite optimal therapy
Direct vasodilators (Hydralazine, Isosorbide)
What is optimal therapy for Af. Am. HF patients
Beta blockers and ACE inhibitors
What does Nitroglycerine do
Venous dilation to decrease preload
What drug dilates both arteries and veins
Sodium Nitroprusside
Who should receive an ICD
Patients with life expectancy longer than 1 year, previous MI and LVEF <30%
Who should receive a Biventricular pacemaker
NYHA class III or IV with EF <35%
What is treatment for CHF stage A patients (ACC/AHA)
TLC
ACE-I
What is treatment for CHF Stage B patients (ACC/AHA)
Every TLC for stage A
ACE/ARB and BB
ICD if EF <30%
What is treatment for CHF Stage C (ACC/AHA)
Everything TLC for A&B, salt restriction
Diuretics, ACE, and BB
ICD or Biventricular pacemaker
What is treatment for CHF Stage D (ACC/AHA)
Everything for A, B, and C Compassionate end of life care Chronic inotropes LVAD Heart transplant
When would a patient need to be URGENTLY hospitalized
New signs of congestion Increased dyspnea Anasarca/ascites Severe decompensating HF New A-Fib
When would you need to IMMEDIATELY hospitalize a patient
with pulmonary edema/ respiratory distress
Desat <90%
SBP <75
Confusion d/t hypoperfusion
What are important markers of poor prognosis
Need for hospitalization Poor compliance Age gender cause race
