CHF Flashcards
Etiologies for CHF
Most common cause is CAD. HTN, diabetes, alcohol abuse, infection, family hx of CM, valvular heart disease
Is CHF a systolic or diastolic problem?
Can be both
Left sided heart failure results in…
pulmonary edema
Right sided heart failure results in…
peripheral edema
Systolic problem resulting in CHF results in…
reduction of cardiac output- syncope, dyspnea, etc. And leads to congestion- R sided or L sided heart failure
Significant dyspnea on exertion seen in systolic or diastolic dysfunction
Diastolic
Causes of diastolic dysfunction in CHF
Myocardial ischemia, myocardial fibrosis, pressure overload hypertrophy, constrictive pericarditis, restrictive cardiomyopathy, HCM, amyloidosis or sarcoidosis CM
Patient presents with dyspnea especially on exertion, fatigue, exercise intolerance, peripheral edema. Decreased concentration, confusion, oliguria tachycardia, . You are suspicious of CHF. What kind of signs do you look for during PE?
Weight changes, blood pressure, pulse, jugular venous distension (due to peripheral edema), pleural effusion, wheezes, rales, displaced PMI, Right ventricular heave, murmurs, gallops, hepatomegaly, splenomegaly
DDx for CHF
Lung disease, pulmonary embolus, Pulm HTN, thyroid disease, arrhythmias, anemia, obesity, cognitive disorders, deconditioning
What does BNP tell you
released from LV when it’s stretched. tells you if patient is in HF or not. If BNP greater than 500, heart failure. If less than 100, not related to heart. 100-500 heart or lungs problem
what labs would you draw in CHF for diagnosis?
TOTAL PROTEIN, ALBUMIN, BUN, CREATININE- to make sure it’s not protein deficiency or leakage in periphery that is causing congestion, liver function tests, CXR, ECG, electrolytes, CBC, lipid panel, urinalysis,
after CHF is diagnosed, figure out cause–
Echo- assess EF, valvular disease, hypertrophy, diastoligy. MUGA scan. Check systolic function - If EF less than 40%. Angiogram or exercise-stress test to r/o ischemia
NYHA classification of CHF
Class 1- asymptomatic. Class 2- symptoms with moderate exertion. Class 3- Symptoms with minimal exertion. Class 4- Symptoms at rest
ACC guidelines for CHF classification
Stage A- no cardiac dysfunction, but at risk for developing heart disease because of lifestyle risk factors (HTN, obesity). Stage B- Evidence of cardiac dysfunction, but no symptoms. Stage C- Evidence of cardiac dysfunctions WITH symptoms. Stage 4- Symptoms of heart failure despite maximal therapy.
Why should you be careful of NSAIDS in hypertension and CHF?
can cause salt retention
1st drug of choice in CHF
ACE-I
contraindications for using ACE-I (for CHF)
renal artery stenosis, renal insufficiency, angioedema, hyperkalemia, severe aortic stenosis
ARBs used in CHF
Candesartan and valsartan
BB MOA in CHF
negative ionotrope, chronotrope.
ACE-I plus BB
Improve EF, survival rate, and reduce sudden death
contraindications for using BB in tx of CHF
bronchial asthma/emphysema, bradycardia, hypotensive, second or third degree heart block
Spironolcactone reduces…
preload
contraindications to using sprinolactone
renal insufficiency, hyperkalemia, gynecomastia
Thiazide diuretics role
Inhibit Na/Cl reabsorption in distal convoluted tubule
Loop diuretics role
Inhibit the Na/K/2Cl symporter in thick ascending limb
What is the first line diuretic
loop diuretics
Digoxin
Positive inotropic agent, enhances contraction.
digoxin should be monitored carefully because toxicity can lead to..
severe bradycardia- digoxin delays AV conduction and reduces sinus node automaticity. Also decreases VR in atrial fibrillation. Can cause vision changes.
Contraindication to using digoxin
kidney function should be normal!
digoxin reduces morbidity or mortality?
reduces morbidity
types of vasodilators used in CHF tx
ACE-I, nitrates, nesiritide, hydralazine
function of ACE-I in tx of CHF
decrease preload (less reabsoption of sodium and water) and afterload (decrease vasoconstriction)
function of vasodilators in tx of CHF
decreases afterload to increase cardiac output
Positive inotropic agents, such as dixogin effect on mortality
good for short term, but long term use increases mortality
types of positive inotropic agents
digoxin, dobutamine milrinone
when to use positive inotropic agents in CHF
if patients have severely decreased CO and not perfusing. Can use it short term to perfuse until cardiac transplant
what anticoagulant indicated for CHF
coumadin if risk of LV thrombus
devices for CHF
implantable cardioverter defibrillator and biventricular pacemaker devices (EF must be less than 35% to be candidates)
