Exam 3 - Acute HF

Question 1

What is most common ADHF and causes? CI and PCWP changes?

Answer 1

Warm and wet. Drug changes, infection, NSAIDs, Na+, EtOH.

Preserved or decreased CI. Increased PCWP

Question 2

What are four compensatory mechanisms for ADHF? What does each do?

Answer 2

1. ET-1=Vasoconstrictor causing LVH and - GFR
2. AVP=AKA ADH
3. ANP=From atrial myocardium d/t atrial dilation causing vasodilation, natruiesus, diuresis
4. BNP=From ventricular mycardium d/t ventricular stretching causing vasodilation, naturiesis, diuresis.

Question 3

What does BNP work against? How is it used to diagnose?

Answer 3

BNP works against ET-1.

DDx between ADHF and Pneumonia. If over 500 when likely cardiac!

Question 4

What things can cause decreased CO/CI?

Answer 4

EtOH
B-blockers
Non-DI CCBs
Some antiarrythmics (Amiodarone is safe!)
Some chemo agents

Question 5

What things can cause increased Na/H2O retention?

Answer 5

Steroids for COPD
NSAIDs
TZD for DM2
Some abx

Question 6

What three measurments can kill PTs faster in hospital?

Answer 6

1. BUN 43+
2. SBP less than 115
3. SCr 2.75+

Question 7

Goal of Acute HF treatment?

Answer 7

Relieve congestion and optimize fluid status

Question 8

Signs of congestion?

Answer 8

Shortness or breath, dyspnea on exertion, edema, orthopnea

Question 9

Signs of hypotension?

Answer 9

Pale skin, cold hands

Question 10

When to use ACEi?

Answer 10

In warm and wet ONLY!

Question 11

Tx for Warm and Wet? Causes?

Answer 11

ACEi/ARB + Loop Diuretic

Perfusion ok, too much fluid intake.

Question 12

Tx for Cold and Dry? Causes?

Answer 12

Gentle hydration. Maybe inotrope (Dobutamine).
DO NOT GIVE ACEi/ARB OR LOOP DIURETIC!

Too vigilant in fluid reduction. Not congested, but hypoperfusion.

Question 13

Tx for Cold and Wet? Causes?

Answer 13

Low-dose vasodilator (NTG, nitroprusside) and Inotrope (dobutamine) to increase CO.

Fluid overload often due to too much B-blocker or Digoxin.

Question 14

How do you double potency of a Loop Diuretic?

Answer 14

Switch from PO to IV. Keep same dose.

Question 15

If resistant to loop diuretic what to do?

Answer 15

Increase dose. Can also add thiazide diuretic for synergy.

Question 16

When to use Beta Blockers in ADHF? When to switch?

Answer 16

Wait until discharge. Reduce dose while in hospital. Switch from Carvedilol to Metoprolol if SBP 115 or less

Question 17

Nitroprusside and kidneys?

Answer 17

NOT USED IN RENAL DYSFUNCTION DUE TO CYANIDE!!!

Question 18

Dopamine MOA and when to give?

Answer 18

B-Agonist by increasing Ca++ during systole. Inotrope which increases contractility and increases CO/CI.

Give to “cold” patients.

Question 19

Milrinone MOA and special effect on veins?

Answer 19

PDE3-inhibitor. Increases contractility and increasing CO/CI. Vasodilator effects “Inodilator”.

Question 20

NTG MOA and when useful? Route?

Answer 20

Nitric Oxide donor which dialates veins. Short-term IV infusion.

Useful in HF w/myocardial ischemia.

Question 21

Which class of meds given to “cold” patients?

Answer 21

Inotropes (Dopamine, Milrinone)