Congestive Heart Failure Flashcards
When to start aldosterone antagonists in heart failure?
When there’s symptomatic heart failure in NYHA functional class II, III, IV and LVEF<35%
Post STEMI and LV EF <40% and symptomatic heart failure or DM2
This stops aldosterone driven cardiac remodeling and also has potassium sparing effect on K wasting of loop and thiazide diuretics and so lowers risk for hypokalemic induced arrhythmia.
So avoid in CrCl pts <30 or K>5
NYHA HF class 1
no symptoms of limitation of physical activity
NYHA HF class 2
slight limitation in physical activity (dyspnea w/ climbing stairs)
NYHA HF class 3
marked limitation of physical activity (dyspnea with house chores)
NYHA HF class 4
inability to perform physical activity without significant discomfort
When should aldosterone antagonists should be avoided in pts with heart failure?
Cr <30 or pts with K >5
When do we give metolazone in patients with heart failure?
when pts who have heart failure and their peripheral edema is refractory to loop diuretics.
They work on a different part of renal tubule
who needs to be on combination of hydralazine and oral nitrates
AA with NYHA classes III and IV heart failure.
When to get cardiac resynchronization therapy with biventricular pacing?
sinus rhythm with persistent symptoms and optimal medical care who have EF<35% or QRS duration >150 msec and LBBB.
When can you use combo of hydralzine and nitrate therapy in addition to goal directed therapy for CHF?
There is a symptomatic and mortality benefit in AA pts with NYHA III and IV HF and have EF<40%
indications for cardiac resynchronization therapy (CRT)
LVEF<35% and sinus rhythm with one of the following: QRS duration >150 msec and NYHA class III and IV symptoms on optimal medical therapy (Grade IA) ORS duration >120 msec but <150 msec and NYHA class III or IV symptoms on on optimal medical therapy undergoing pacemaker or ICD implantation with anticipated frequent ventricular pacing LVEF<30% and QRS duration >150 msec with LBBB, NYHA class I or II symptoms on optical medical therapy.
bivendricular pacing has helped to do what for pts with heart failure?
increase exercise tolerance, reduce need for hospitalization and decrease overal mortality and they decrease risk for sudden cardiac death.
in acute heart failure when do we initiate inotropes to help with augment forward flow and assist in ventricular offloading
when there’s acute heart failure exacerbation and volume overload, reduced cardiac index and lack of response to high dose IV diuretics. Start with milrinone or dobutamine. Dobutamine is favored in renal dysfunction.
Side effect of milrionone?
renally metabolized and accumulation can lead to hypotension
indications for ICD (implantable cardioverter defibrillator) placement for primary prevention and secondary prevention of VT?
primary prevention:
prior MI with LVEF<30%
NYHA class II or III and LVEF<35%
Secondary prevention:
prior VF or unstable VT without reversible cause
prior sustained VT with underlying cardiomyopathy
CHF review chart
Stages in development of heart failure
heart failure with perserved LV EF
causes and management of HFpEF
How to estimate central venous pressure CVP
cor pulmonale
