CHF

Question 1

Pump failure that fails to meet the metabolic demands of the body. May be structural or functional cardiac disorder

Answer 1

HF definition - usually hypovolemic

Question 2

Contractile state, preload, afterload, HR govern

Answer 2

CO

Question 3

LV EF is low and there is eccentric remodeling

Answer 3

Systolic HF

HFrEF

Question 4

LV systolic function is preserved. High filling pressure. Concentric remodeling.

Answer 4

HFpEF

ventricular stiffness

Question 5

Causes of HFrEF

Answer 5

1) Cardiac Ischemia
2) Severe HTN
AS, valvular regurg

Question 6

Causes of HFpEF

Answer 6

HCM, RCM, Tamponade, constrictive pericaditis,

Question 7

LVEF levels are

Answer 7

50-70% normal
Borderline = 40-50%
Low< 40%

Question 8

LV failure causes

Answer 8

Arrhythmias (A-fib), valvular disease, CM, high output states (anemia, Hyperthyroidism)

Question 9

RV failure causes

Answer 9

PE, OSA, Infective endocarditis, Pulm HTN

Question 10

Biventricular Failure

Answer 10

LV failure, CM, Arrhythmias, Anemia, Paget, Beri Beri

Question 11

Acute HF causes

Answer 11

Myocardial infarct, ventricular septum wall rupture, PE, Tamponade.

Question 12

ACC/AHA stages

Answer 12

A: high risk HF w/o structual HF or sxs (HTN)
B: Structural Heart disease w/o Sxs (LV dysfunc)
C: Structural heart disease w/ HF sxs
D: Refractory HF

Question 13

NYHA classes

Answer 13

I) Asympt
II) sxs with moderate exertion
III) Sxs w/ min exertion
IV) sxs at rest

Question 14

LV failure SXS

Answer 14

Dysnpea, fatigue, weight gain, JVP, PND

Question 15

RV failure SXS

Answer 15

Edema, JVD, S3 gallop, Hepatomegaly, Ascites, Anasarca

Question 16

what labs do you order to diag HF?

Answer 16

CBC (anemia)
CMP (HypoK - arryhthmia, HyperK - RAAS, Hyponatremia - RAAS, BUN, Creatinine)
ABG: hypoxia and respiratoru alki in early HF
- low low 02 and metabolic acid in late HF

Question 17

How do you measure BNP

Answer 17

<100 - exclude HF
100-400 - borderline
>400 Consistent with HF

Question 18

What diagnositic imaging test do you order for HF?

Answer 18

EKG: ACS, dysrrythmias, low-voltage, cardiomegaly, kerley B (pulm edema), bat wings (alveolar edema)
Echo: etiology of HF (AS, Hypertrophy, tamponade, and EF)

Question 19

How do you rule out CAD and valvular disease, and measure the pressure directly?

Answer 19

Cardiac catheterization

Question 20

What are the overall tx goals of HF?

Answer 20

improve quality of life, cardiac function, prevent death and hospitalization.

Question 21

Stage A HF treatment?

Answer 21

treat the underlying cause (anemia, infection, thyrotoxicosis)

Question 22

what are some non-pharm tx of HF

Answer 22

Lifestyle changes, reduce carbs (or increase if cardiac cachexia), restrict salt, use support stockings.

Question 23

What is the initial drug tx inHF

Answer 23

Diuretics and ACE

Question 24

What medication do you avoid in HF

Answer 24

Beta blockers and CCM

Question 25

What meds decreases preload, sxs relief, but you need to monitor hypo/hyperkalemia?

Answer 25

Diuretics (thiazides, loops)

Question 26

How does furosimide tx HF

Answer 26

venodilation, diaresis, decrease preload.

Question 27

What drug do you give a HF patient if they are in NYHA class 3 or 4 and LVEF<35% OR LVEF < 40% with AMI

Answer 27

Potassium sparing or Spironolactone

Question 28

How does spironolactone help pts with HF

Answer 28

prevents cardiac remodeling, fibrosis, and Na retention

Question 29

What med reduces both preload and afterload & used if HFrEF < 40%

Answer 29

ACE/ARB

Question 30

What med do you only give if the patient has stable HF caused by LV dysfunction

Answer 30

Beta blockers

Question 31

What are some precautions with beta blockers

Answer 31

hypoglycemia, astham, airway problems, bradycardia, hypotension

Question 32

What med has not improved survival from HF but provides SXS relief?

Answer 32

Digoxin, only used if patient has sxs after taking and ACE/ARB, and Beta-blocker

Question 33

When can you give hydralazine?

Answer 33

reduce PVR (afterload) especially in black patients

Question 34

What is the stnd recommended therapy in black patients

Answer 34

Beta blockers, ACE/ARB, hydralazine if pt is in NYHA 2,3,4

Question 35

What drug venodilates and reduces preload in patients with HF and ischemic heart disease?

Answer 35

Nitrates

Question 36

what drug dilates both arteries and veins, and increase CO by reducing ventricular filling pressure

Answer 36

Nitropress

Question 37

compare ICD and Pacemaker

Answer 37

``` ICD: monitor HR and give a shock to correct arryhthmia. if Pt is in NYHA class 2/3 and has EF<35% OR MI and EF <30% Pacemaker: NYHA class 3/4 and EF <35% ```

Question 38

When do you urgently hospitalize a patient with HF

Answer 38

Congestion, hypoperfussion, dyspnea not responding to diuretics, Anasarca, hepatic distension, ascites. new A-fib

Question 39

Immediatly hospitaliza a patient if they are...

Answer 39

No Hx of hypoxia w/ 02 sat < 90%. BP< 75, Pulm edema or respiratory distress, confusion due to hypoperfusion.