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CMT > Congestive Heart Failure > Flashcards

Congestive Heart Failure Flashcards

1
Q

CHF

causes

10

A
  1. MI
  2. arrhythmias
  3. uncontrolled HTN
  4. dietary/med noncompliance
  5. substance abuse
  6. anemia
  7. hyper thyroidism
  8. AKI
  9. PE
  10. sepsis
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2
Q

CHF

what is it?

A

sx of hypervolemia due to impaired cardiac function (decreased filling/decreased squeezing)

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3
Q

CHF

normal EF

A

55-65%

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4
Q

CHF

what do you need to differentiate? how do you do it?

A
  1. HFpEF vs HFrEF
  2. echo
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5
Q

CHF

describe Stage A

A

pateitns at risk for CHF but without sx, structural changes, or elevated biomarkers

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6
Q

CHF

describe Stage B

A

patients without current sympoms of CHF, but has one of the following:
* structural heart disease
* abnormal cardiac function
* elevated cardiac biomarkers

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7
Q

CHF

describe stage C

A

patients with current or prior symptoms and/or structural changes and/or elevated cardiac biomarkers

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8
Q

CHF

describe Stage D

A

severe sx at rest, recurrent hospitalizations despite GDMT, intolerant to GDMT, requires advanced therapies (transplant, mechanical circulation), palliative care

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9
Q

CHF

a pt present with new dx of CHF. Echo shows EF is 55%. What is the best documentation?

A

acute HFpEF

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10
Q

CHF

presentation of right sided

3

A
  1. pedal edema
  2. abdominal bloating
  3. nausea/decreased appetite
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11
Q

CHF

presentation of left sided

4

A
  1. DOE/SOB
  2. orthopnea
  3. cough
  4. decreased exercise tolerance
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12
Q

CHF

Physical Exam Findings of Right Sided

6

A
  1. distended neck veins (JVP > 8cm)
  2. abd distension
  3. pedal edema (1-4+)
  4. hepatojugular reflux
  5. ascites
  6. liver enlargement/tenderness
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13
Q

CHF

PE findings of left sided

3

A
  1. rales/crackles/wheezes
  2. dullness to percussion
  3. S3, S4, or gallop
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14
Q

signs/sx of low perfusion

6

A
  1. narrow pulse pressure
  2. sleepy
  3. low sodium
  4. cool extremities
  5. hypotension on ACE
  6. renal/hepatic dysfunction
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15
Q

signs/sx of congestion

6

A
  1. orthopnea/PND
  2. JVP distension
  3. hepatomegaly
  4. edema
  5. rales
  6. abd jugular reflux
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16
Q

CHF

Lab work up

4

A
  1. BMP or CMP
  2. BNP or pro-BNP
  3. TSH
  4. CBC
17
Q

CHF

diagnostic work up

3

A
  1. echo
  2. EKG
  3. CXR
18
Q

CHF

what can falsely lower BNP?

A

obesity or CKD

19
Q

CHF

what can falsely elevate BNP?

A

ARNI (entresto)

20
Q

CHF

EKG findings?

4

A
  1. LVH
  2. afib or atrial flutter
  3. LBBB
  4. Q waves (old MI?)
21
Q

CHF

CXR findings

ABBCDEE

A
  1. Alveolar edema
  2. Blunting of margins
  3. Kerley B lines
  4. Cardiomegaly
  5. Dilated upper lobe vessels
  6. Pleural effusion
  7. PE
22
Q

CHF

how to navigate CHF?

4 components

A
  1. Dx (echo, BNP, then stage)
  2. work up (reversible?, est baseline tests)
  3. Treat sx
  4. follow up
23
Q

CHF

4 components of tx

A
  1. symptom relief
  2. tx of underlying disorders
  3. education
  4. Rx: fantastic 4
24
Q

CHF

what are the fantastic 4 meds?

A
  1. BB
  2. ARNI/ACE/ARB
  3. Spironolactone
  4. SGLT-2 Inhibitor
25
Q

CHF

which meds provide sx relief?

A

loop diuretics

26
Q

CHF

what education can be provided?

A
  1. low sodium diet
  2. 2L fluid restriction
  3. exercise
  4. optimal BMI
  5. med compliance
  6. watch for warning sx
27
Q

CHF

tx of HFpEF with LVEF < 50%

A
  1. Diuretics PRN
  2. SGLT2
  3. ARNI
  4. MRA
  5. ARB
28
Q

CHF

heart failure tx goals

A
  1. BP < 120/80
  2. HR: < 70 bpm
  3. Euvolemic (warm + dry)
28
Q

CHF

tx of HfmrEF

A
  1. Diuretics PRN
  2. SGLT2
  3. ACE/ARB/ARNI
  4. MRA
  5. BB
29
Q

CHF

which loop diuretics?

3

A
  1. furosemide
  2. torsemide
  3. bumetanide
30
Q

CHF

which SGLT-2 Inhibitors?

3

A
  1. dapagilflozin
  2. empagliflozin
  3. canagliflozin
31
Q

CHF

which ARNI?

A
  1. entresto
32
Q

CHF

which MRAs?

2

A
  1. Spironolactone
  2. Eplerenone ($$)
33
Q

CHF

which BB should be avoided in CHF?

A

atenolol

34
Q

CHF

which BB are most rec for CHF?

A
  1. carvedilol
  2. metoprolol
35
Q

CHF

drugs to avoid if EF < 40%

A
  1. NSAIDs or COX-2 inhibitors
  2. CCBs: diltiazem, verapamil
  3. ACE/ARNI/ARB combos
  4. thiazolidinediones (pioglitazone, rosiglitazone)
  5. sulfonylureas
36
Q

CHF

what does “ I NEED HELP” stand for for CHF tx

A
  • I: intravenous inotropes
  • N: NYHA calss IIIB to IV or persistently elevated natriuretic peptides
  • E: end organ dysfunction
  • E: EF < 35%
  • D: defibrillation
  • H: hospitalizations > 1
  • E: edema despite escalating diuretics
  • L: low systolic BP (< 90), high HR
  • P: prognostic medication; progressive tolerance or down-tiltration of GDMT

CMT (78 decks)

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