Exam 2: Acute Heart Failure

Question 1

ADHF CO

Answer 1

2-4

Question 2

ADHF CI

Answer 2

1.3-2.0

Question 3

PCWP ADHF

Answer 3

18-30

Question 4

ADHF SVR

Answer 4

1500-3000

Question 5

Maintaining Chronic Therapy While Hospitalized

Answer 5

continues meds unless pt becomes hemodynamically unstable or goes into shock

Question 6

Beta Blockers

Answer 6

do not stop unless recent initiation or up-titration in current decompensation

hold if dobutamine is needed or hemodynamically unstable

Question 7

digoxin

Answer 7

avoid d/c unless compelling reason

Question 8

Warm and Dry

Answer 8

optimize chronic therapy

Question 9

Warm and wet

Answer 9

iv diuretics and iv venous vasoilator

Question 10

cold and dry

Answer 10

PWCP ≥ 15: IV inotrope

PCWP < 15: IV fluids until PCWP is 15-18

Question 11

cold and wet

Answer 11

IV diuretics +

SBP<90: iv inotrope
SBP>90: iv arterial vasodilator

Question 12

Loops

Answer 12

exceed chronic daily dose given as intermittent bolus

increase dose to ceiling

add oral MTZ (2.5) HCTZ (12.5) CTZ (250)

Question 13

Vasodilator

Answer 13

used in combo with diuretics to reduce pulmonary congestion

II and IV HF

reduce preload

patients with symptomatic hypotension should not recieve vasodilators

considered over inotropes

Question 14

Nitroprusside clinical effects

Answer 14

balanced vasodilator
decreased SVR

Question 15

nitroprusside use

Answer 15

HTN crisis

Question 16

nitroprusside aes

Answer 16

cyanide and thiocynate toxicity

Question 17

nitroglycerin clinical effects

Answer 17

venous > arterial VD
decreased PCWP

Question 18

nitroglycerin use of adhf

Answer 18

ACS, HTN crisis
warm and wet

Question 19

nitroglycerin AEs

Answer 19

hypotension
headache
reflex tach
nitrate intolerance

Question 20

nesiritide (natrecor)

Answer 20

balanced vasodilation

Question 21

dobutamine MOA

Answer 21

positive inotropes

stimulates AC to increase cAMP

consider if low bp

Question 22

Milrinone MOA

Answer 22

inodilator

PDE inhibitor increases cAMP in myocardium (increases CO) and vaseculture (dec SVR)

Question 23

Milrinone clinical effects

Answer 23

venous >arterial vasodilator

consider if on a bet blocker

Question 24

Milrinone brand name

Answer 24

primacor

Question 25

use of inotropes

Answer 25

cold ad wet (IV)
cold and dry (if PCWP >15)

Question 26

Use of Dopamine in ADHF

Answer 26

typically plays secondary role to dobutamine/milrinone

referred to as a vasopressor

Question 27

choice of dobutamine vs milrinone is individualized

Answer 27

high svr

beta blocker use

Question 28

when to use positive inotorpe therpay

Answer 28

COld