Exam 1 - HF Flashcards
Structural or functional cardiac disorder that impairs the ability of ventricle to fill with or eject blood (disorder of impaired CO)
HF
2 symptoms of HF:
Dyspnea
Fatigue
2 signs of HF:
Edema
Rales
Is there a diagnostic test for HF?
No
Systolic dysfunction ventricular emptying; increased or decreased?
Decreased
What does diastolic dysfunction heart look like?
Increased heart wall
What 3 things occur with chronic use of Frank-Starling?
Sodium retention
Water retention
Venoconstriction
When is sympathetic nervous system triggered?
Decrease in CO
What does sympathetic nervous system activate?
RAAS
What 3 things occur with activation of RAAS?
- Water retention
- Increased contractility
- Vasoconstriction
What does RAAS trigger?
Aldosterone
Diagnosis of HR requires the simultaneous presence of what?
2 major criteria
1 major criterion with 2 minor criteria
BNP >500 pg/ml
NT-proBNP >1800 pg/ml
Likely HF
What 3 things do you have to rule out with somewhat elevated BNP?
- Pulmonary embolism
- Renal failure
- Pulmonary HTN
What stage: Patients at high risk for developing HF?
Stage A
What stage: pts with structural heart disease but no HF s/s?
Stage B
What stage: pts with structural heart disease and current or previous symptoms?
Stage C
What stage: refractory HF requiring specialized interventions?
Stage D
What stage examples: HTN, CAD, atherosclerosis, DM, obesity, metabolic syndrome
Stage A
What stage examples: previous MI, LV hypertrophy, LV systolic dysfunction
Stage B
What stage examples: LV systolic dysfunction and symptoms (dyspnea, fatigue, and reduced exercise tolerance)
Stage C
What stage examples: pts with treatment refractory symptoms at rest despite max medical therapy
Stage D
What class: no symptoms
Class 1
What class: symptoms with moderate exertion
Class 2
What class: symptoms with minimal exertion
Class 3
What class: symptoms at rest
Class 4
5 steps of treatment:
- Establish Dx of HFrEF; assess volume, initiate GDMT
- Consider scenario
- Implement indicated GDMT
- Reassess symptoms
- Consider additional therapy
Is metoprolol tartrate or carvedilol better for chronic HF?
Carvedilol
What period with effects from BB:
- negative inotropy
- reduced HR
- improved myocardial substrate utilization
- some with increased signs of reduced CO
- some with symptomatic relief
Days to weeks
What period with effects from BB:
- improvement in invasive and non invasive measurements of cardiac function
- stabilization of clinical symptoms
Weeks to months
What period with effects from BB:
- improvement in clinical symptoms and possibly physical capacity
- reduced risk of hospitalization and death
Months to 1yr
How much do you increase BB dose?
50-100% every 2-4wks
Decreases spontaneous pacemaker activity of SA node:
Ivabradine
What does ivabradine do overall?
Slow HR
What treatment to use with symptomatic HFrEF if HR >70 while on max BB?
Ivabradine
3 adverse effects of ivabradine:
- Bradycardia
- Atrial fibrillation
- Luminous phenomena
What is recommended in pts with symptomatic HF and EF <40%?
ACE inhibitors
Do you continue ACE inhibitors perioperatively in HF pts?
YES
What is recommended in pts with HF and EF <40% that are intolerant to ACE inhibitors because of cough or angioedema?
ARB
Do you continue ARBs perioperatively in HF pts?
YES
What do you add to pts with background ACE-I and BB therapy in pts with symptomatic HF and EF <40%?
Aldosterone antagonist
What are the 2 aldosterone antagonists?
Spironolactone
Eplerenone
What 2 contraindications are for aldosterone antagonists?
- Potassium >5
2. CrCl <30
What drug: Venodilation and reductions in preload; increase in NO
Isosorbide dinitrate
What drug: artieral dilation to reduce afterload and increase SV and CO; increase in NO
Hydralazine
What attenuates myocardial remodeling and may play a protective role in HF?
NO
What is recommended to be added on for black HF pts who remain symptomatic despite optimal medical therapy?
Hydralazine/isosorbide dinitrate
First line therapy in all HF pts unable to tolerate either ACE-I or ARBs because of renal insufficiency, hyperkalemia, or hypotension?
Hydralazine/isosorbide dinitrate
What drug for HF pts who have evidence of fluid retention?
Diuretics
Which diuretic is better: loop or thiazide?
LOOP
What type of diuresis:
- dyspnea on exertion
- increased lower extremity and abdominal swelling
- increased wt
Under
What type of diuresis:
- blood urea nitrogen increased to 61
- serum creatinine increased to 2.5
- orthostatic BP changes with standing
Over
What drug increases parasympathetic activity?
Digoxin
What drug
- increases CI
- decreases preload with little effect on BP
Digoxin
Does digoxin have a narrow therapeutic range
Women, older pts, pts with impaired renal function
YES
What is indicated in pts who have symptomatic HF, LVEF <35%, and widened QRS complex?
Cardiac resychronization therapy (CRT)
Is there any evidence-based treatment for HFpEF?
NO
Rapid onset or change in s/s of HF, resulting in need of urgent therapy
Acute HF
What does acute HF look like on graph?
Upward slopes gradually going down
Main medical management for AHFS?
Based on precipitating factors and clinical presentation
What should be started with warm and wet AHFS?
Loop diuretics
Warm and wet AHFS in pts with fluid overload in a sense of systemic hypotension, what should be used?
Nitroglycerin
Nitroprusside
Effect of HF treatment should be monitored with measurement of what 4 things?
- Fluid intake and output
- Vital signs
- Body wt
- Perfusion and congestion
Cold and wet AHFS in pts, what drugs should be used? (4)
- Dopamine
- Dobutamine
- Milrinone
- NorE
What 4 things do you monitor intraoperative?
- Intraarterial P
- Pulmonary artery catheter
- TEE
- Esophageal Doppler monitor
