CHF Flashcards

Question

What are some reversible/precipitating causes of hypertrophy

Answer 1

Increased metabolic demands (infection, anemia, hyperthyroid, etc.) Increased preload (excessive sodium, excessive fluid intake/administration, renal failure) Increased afterload (pneumonia, uncontrolled hypertension, PE) Impaired contractility (negative inotropic medications, myocardial ischemia, ethanol) Medication non-adherence

Answer 2

``` Chest x-ray CBC, CMP, BNP TSH, urinalysis EKG Echocardiogram ```

Answer 3

n-terminal-pro-BNP (nt-pro-BNP) synthesized and secreted by the ventricular myocardium in response to increases in volume or pressure Renally excreted Okay for use in evaluation of dyspnea, but in general not recommended for serial measurement

Answer 4

Good primary care – HTN and Hyperlipidemia Treat underlying condition – valve repair/replacement, coronary artery revascularization, antihypertensives, alcohol cessation, rhythm reestablishment Eliminate acute precipitating cause – infection, arrhythmia, salt intake, medication changes, thyroid, etc. Treatment of heart failure symptoms Diuretics Vasodilators and positive inotropic drugs Modulation of the neurohormonal response

Answer 5

Dietary – sodium restriction, alcohol cessation, caffeine avoidance Smoking Cessation Exercise – may be monitored (cardiac rehab), mild-moderate intensity ~ about 60% of maximal heart rate. Should try to get within 10% of ideal body weight if obese Daily Weights – same scale, first thing in the morning after initial urination. Need to contact provider with 2 lb weight gain in one day, or 5 lbs in one week. Can often be given a “sliding scale” to titrate their diuretic dosing. Medications – do not miss doses or prescriptions and avoid NSAIDs, Calcium Channel Blockers, and thiazolidinediones Vaccines

Answer 6

With the use of diuretics it is possible to decrease the preload so that the hydrostatic pressure no longer causes pulmonary/venous congestion Should not effect cardiac output since the Frank Starling curve has “flattened” Most effective diuretics are the loop diuretics (furosemide, bumetanide, torsemide, ethacrinic acid) Possible side-effects of hypokalemia, hypomagnesia, orthostatic hypotension, lethargy/drowsiness Monitor kidney function and electrolytes

Answer 7

Venous vasodilators – nitrates Arteriole vasodilators – hydralizine “Balanced” vasodilators – ACE-I, ARB, hydralizine+isosorbide dinatrate Nesiritide – recombinant BNP (intravenous drip)

Answer 8

Help to break the cycle of the RAAS Antihypertensive (afterload) Renal protective Indicated post myocardial infarction

Answer 9

``` Hypotension Acute Renal Failure Hyperkalemia Cough Angioedema ```

Answer 10

Help to break the cycle of the RAAS Antihypertensive (afterload) Renal protective Indicated post myocardial infarction

Answer 11

Cough (3 versus 9%) Angioedema Hypotension

Answer 12

Spironolactone and Epleronone | Monitor kidney function and potassium for risk of hyperkalemia

Answer 13

Initially contraindicated Only carvedilol (β1 and β2 as well as weak α1), bisoprolol (β1), and sustained release metoprolol (β1) have been studied and approved for heart failure Improves indices of LV function, delays progression of myocardial dysfunction, and improves survival (MERIT-HF 1999) Monitor blood pressure and heart rate (sympathetic nervous system blockade)

Answer 14

``` Recommended for patients self-described as African Americans with NYHA class III–IV receiving optimal therapy with ACE inhibitors and beta blockers. It can be useful in those who cannot be given an ACE or ARB because of drug intolerance, hypotension, or renal insufficiency. ```

Answer 15

no!! not for 36+ hours, also it costs $$$$$$$$

Answer 16

positive inotrope Digitalis – must monitor blood level (goal between 0.5 and 0.8 ng/mL ) Class II-IV despite optimal therapy should get Digoxin Symptomatic relief, but no morbidity/mortality benefit Indicated for atrial fibrillation

Answer 17

``` Iron therapy, Sleep study, Cardiac Resynchronization Therapy (CRT) Internal Cardiac Defibrillator (ICD) Anticoagulation Cardiac Assist Device Cardiac Transplant ```

Answer 18

``` Paroxysmal nocturnal dyspnea Orthopnea Elevated jugular venous pressure Pulmonary rales Third heart sound Cardiomegaly on chest x-ray Pulmonary edema on chest x-ray Weight loss ≥4.5 kg in five days in response to treatment of presumed heart failure ```

Answer 19

``` Bilateral leg edema Nocturnal cough Dyspnea on ordinary exertion Hepatomegaly Pleural effusion Tachycardia (heart rate ≥120 beats/min) Weight loss ≥4.5 kg in five days ```

Answer 20

Complete history and physical examination History of alcohol, illicit drugs, standard or "alternative" therapies, and chemotherapy drugs Ability to perform routine and desired activities of daily living Assessment of volume status, orthostatic blood pressure changes, height and weight, and calculation of body mass index CBC, urinalysis, CMP, glucose (A1C?), lipid profile, and thyroid panel EKG and CXR Echocardiogram Cardiac cath if concern for ischemia