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Nayla Foundations > CHF > Flashcards

CHF Flashcards

1
Q

What state does CHF result in

A

Hypervolemic state

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2
Q

What is CHF

A

inability of the heart to pump blood in proportion to metabolic demands
-A disease of aging

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3
Q

What is cardiac output of the heart governed by

A

Preload
After load
Contractile state of myocardium
Heart rate

CO=HRxSV

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4
Q

What happens in systolic HF

A

LV EF reduced

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5
Q

What happens in diastolic HF

A

altered ventricular compliance causes high filling pressures

EF not affected

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6
Q

What are the causes of Systolic HF

A 
#1: CAD with MI (ischemia in US)
#2: HTN
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7
Q

What are the causes of diastolic HF

A

Abnormal ventricular filling

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8
Q

What are causes of LV failure

A

arrhythmia
valve disease
cardiomyopathy

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9
Q

What are causes of RV failure

A

Left sided HF!

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10
Q

What is the ACC/AHA classification

A

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

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11
Q

What is the NYHA classification

A

I: Asymptomatic
II: Symptomatic with moderate exercise
III: Symptomatic with minimal exercise
IIII: Symptomatic at rest

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12
Q

What are signs of LV HF

A 
Pulmonary HTN
Pulmonary edema
Crackles
Fatigue
Dyspnea
Elevated JVD
PND
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13
Q

What are signs of RV HF

A

Hepatomegaly
Peripheral edema
Anasarca
Ascites

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14
Q

What HF is hepatojugular reflux associated with

A

Both left and right

(looking for 4cm rise or fall

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15
Q

When is S3 seen

A

With CHF, indicative of fluid sloshing into the dilated ventricles

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16
Q

When is S4 seen

A

In diastolic failure, when the walls are too stiff to allow filling

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17
Q

What would you get a CBC to check

A

Anemia (low H&H), which causes a high output failure

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18
Q

What would a CMP reveal

A

hypo/hyperkalemia
hyponatremia
high BUN/Cr
hight LFT

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19
Q

What is BNP

A

enzyme released from heart in response to ventricular pressure overload

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20
Q

What are the important BNP levels

A

<100: NOT CHF

>400: consistent with CHF

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21
Q

What are optimal oxygen sat levels

A

> 92%

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22
Q

What ABG’s will you see with early CHF

A

Hypoxia
Hyperventilation
Respiratory ALKalosis

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23
Q

What ABG’s will you see with critical CHF

A

Worsening CHF

Metabolic alkalosis

24
Q

What is cardiomegaly

A

Cardiac silhouette is greater than 1/2 transthoracic diameter

25
Q

What will you see on CXR in CHF

A

Cardiomegaly
Kerley B Lines
bilateral hilar infiltrates

26
Q

What does a normal size heart with CHF indicate

A

Mitral stenosis
Constrictive pericarditis
AMI

27
Q

What is the most useful non-invasive diagnostic tool for CHF

A

Echo

Evaluates Etiology and Extent of HF

28
Q

What does a cardiac cath provide

A

Direct measurement of ventricular diastolic pressure

can show impaired relaxation and filling

29
Q

What does “optimal therapy” require

A

Combo of:
Multiple meds
TLC
Surgical therapies

30
Q

What vaccines should HF patients receive

A

Flu

Pneumococcal

31
Q

What is initial pharmacologic therapy in HF

A

combination of diuretic and ACE-I

32
Q

What drug should be AVOIDED in HF

A

CCB- can worsen HF

33
Q

What do diuretics do

A

Decrease preload in fluid overload patients (make you pee out so you have less fluid that fills the ventricles)

34
Q

What diuretics are good for outpatient management, though they are not as good as loops

A

Thiazides

35
Q

What diuretics are most useful in CHF patients

A

Loop diuretics

36
Q

Why is Spironolactone good to add to loop and thiazide

A

It is an aldosterone antagonist, and aldosterone is usually high in CHF

37
Q

What must you monitor when taking Spironalactone

A

Hyperkalemia

38
Q

What do ACE-I do

A

reduce both preload and after load

39
Q

When are ARB’s useful

A

When patients are unable to take ACE due to angioedema or cough

40
Q

Who are BB especially useful in

A

all stable patients with HF!

Hx MI, EF <40% and asymptomatic, stable HF

41
Q

What are BB known to do

A

reduce hospitalizations, sudden death, overall mortality in CHF

42
Q

What drug relieves symptoms but does NOT improve survival

A

Digoxin (increases CO)

43
Q

What med should be considered for Af.Am. patients and those who remain symptomatic despite optimal therapy

A

Direct vasodilators (Hydralazine, Isosorbide)

44
Q

What is optimal therapy for Af. Am. HF patients

A

Beta blockers and ACE inhibitors

45
Q

What does Nitroglycerine do

A

Venous dilation to decrease preload

46
Q

What drug dilates both arteries and veins

A

Sodium Nitroprusside

47
Q

Who should receive an ICD

A

Patients with life expectancy longer than 1 year, previous MI and LVEF <30%

48
Q

Who should receive a Biventricular pacemaker

A

NYHA class III or IV with EF <35%

49
Q

What is treatment for CHF stage A patients (ACC/AHA)

A

TLC

ACE-I

50
Q

What is treatment for CHF Stage B patients (ACC/AHA)

A

Every TLC for stage A
ACE/ARB and BB
ICD if EF <30%

51
Q

What is treatment for CHF Stage C (ACC/AHA)

A

Everything TLC for A&B, salt restriction
Diuretics, ACE, and BB
ICD or Biventricular pacemaker

52
Q

What is treatment for CHF Stage D (ACC/AHA)

A 
Everything for A, B, and C
Compassionate end of life care
Chronic inotropes 
LVAD
Heart transplant
53
Q

When would a patient need to be URGENTLY hospitalized

A 
New signs of congestion
Increased dyspnea
Anasarca/ascites
Severe decompensating HF
New A-Fib
54
Q

When would you need to IMMEDIATELY hospitalize a patient

A

with pulmonary edema/ respiratory distress
Desat <90%
SBP <75
Confusion d/t hypoperfusion

55
Q

What are important markers of poor prognosis

A 
Need for hospitalization
Poor compliance
Age
gender
cause
race

Nayla Foundations (18 decks)

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