CHF Flashcards

1
Q

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

A

HF definition - usually hypovolemic

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2
Q

Contractile state, preload, afterload, HR govern

A

CO

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3
Q

LV EF is low and there is eccentric remodeling

A

Systolic HF

HFrEF

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4
Q

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

A

HFpEF

ventricular stiffness

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5
Q

Causes of HFrEF

A

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

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6
Q

Causes of HFpEF

A

HCM, RCM, Tamponade, constrictive pericaditis,

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7
Q

LVEF levels are

A

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

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8
Q

LV failure causes

A

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

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9
Q

RV failure causes

A

PE, OSA, Infective endocarditis, Pulm HTN

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10
Q

Biventricular Failure

A

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

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11
Q

Acute HF causes

A

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

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12
Q

ACC/AHA stages

A

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

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13
Q

NYHA classes

A

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

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14
Q

LV failure SXS

A

Dysnpea, fatigue, weight gain, JVP, PND

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15
Q

RV failure SXS

A

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

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16
Q

what labs do you order to diag HF?

A

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

17
Q

How do you measure BNP

A

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

18
Q

What diagnositic imaging test do you order for HF?

A

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

19
Q

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

A

Cardiac catheterization

20
Q

What are the overall tx goals of HF?

A

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

21
Q

Stage A HF treatment?

A

treat the underlying cause (anemia, infection, thyrotoxicosis)

22
Q

what are some non-pharm tx of HF

A

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

23
Q

What is the initial drug tx inHF

A

Diuretics and ACE

24
Q

What medication do you avoid in HF

A

Beta blockers and CCM

25
Q

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

A

Diuretics (thiazides, loops)

26
Q

How does furosimide tx HF

A

venodilation, diaresis, decrease preload.

27
Q

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

A

Potassium sparing or Spironolactone

28
Q

How does spironolactone help pts with HF

A

prevents cardiac remodeling, fibrosis, and Na retention

29
Q

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

A

ACE/ARB

30
Q

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

A

Beta blockers

31
Q

What are some precautions with beta blockers

A

hypoglycemia, astham, airway problems, bradycardia, hypotension

32
Q

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

A

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

33
Q

When can you give hydralazine?

A

reduce PVR (afterload) especially in black patients

34
Q

What is the stnd recommended therapy in black patients

A

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

35
Q

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

A

Nitrates

36
Q

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

A

Nitropress

37
Q

compare ICD and Pacemaker

A
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%
38
Q

When do you urgently hospitalize a patient with HF

A

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

39
Q

Immediatly hospitaliza a patient if they are…

A

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