Heart Failure

Question 1

What 3 compensations are made in heart failure?

Answer 1

increased preload, increased afterload, increased contractility

Question 2

What does low cardiac output and increased afterload do to renal perfusion?

Answer 2

decreases it

Question 3

What does a decrease in renal perfusion cause?

Answer 3

fluid and sodium retention

Question 4

What results from elevations in preload (volume overload)?

Answer 4

ventricular dilatation

Question 5

Acute exacerbations of CHF results in what?

Answer 5

poor cardiac function and fluid accumulation in the lung with hypoxia

Question 6

What causes low-output HF?

Answer 6

primary heart disease like coronary artery disease, severe hypertension, valve disease, cardiomyopathy, dysrhythmias

Question 7

What causes high-output HF?

Answer 7

increase metabolic demands like thyrotoxicosis, severe anemia, AV fistula, Beriberi (thiamine deficiency), paget’s disease

Question 8

What are clinical features of left heart failure?

Answer 8

dyspnea, orthopnea, PND, weakness, fatigue, tachycardia, S3, rales

Question 9

What are the clinical features of right heart failure?

Answer 9

JVD, peripheral edema, RUQ pain, hepatojugular reflux, hepatomegaly, ascites

Question 10

What labs could be abnormal in HF?

Answer 10

anemia, renal insufficiency, elevated LFTs, hyponatremia (due to fluid overload diluting sodium)

Question 11

What specific lab study will be elevated in HF?

Answer 11

BNP

Question 12

What will CXR show in HF?

Answer 12

cardiomegaly, cephalization, kerley B lines, alveolar fluid, pleural effusions

Question 13

What is done to manage chronic HF?

Answer 13

exercise, low-sodium diet, manage hypertension

Question 14

Which meds decrease preload?

Answer 14

nitrates and diuretics (loop or thiazide)

Question 15

What med decreases afterload?

Answer 15

ACE inhibitors–improve cardiac output and improve renal perfusion

Question 16

What med decreases catecholamine levels (decreasing afterload) and helps with dysrhythmias?

Answer 16

beta-blockers

Question 17

What are the two most important anti-hypertensives to use in chronic HF?

Answer 17

ACE inhibitors and beta-blockers

Question 18

When patients with chronic HF have low ejection fraction what should they be on?

Answer 18

anti-coagulants

Question 19

What physiological causes account for acute decompensated HF?

Answer 19

increased preload, increased afterload or decrease left ventricular function

Question 20

What should be done initially in acutely decompensated HF?

Answer 20

100% O2-bipap or cpap is fine

Question 21

If the acutely decompensated HF patient needs to be intubated what should be added on the vent?

Answer 21

positive end-expiratory pressure (PEEP)

Question 22

In acutely decompensated HF what should be used to decrease preload?

Answer 22

nitroglycerin is best but loop diuretics can be used too

Question 23

In acutely decompensated HF what should be used to decrease afterload?

Answer 23

nitroglycerin works for this too but you can use ACE inhibitors too

Question 24

In acutely decompensated HF what should be used to improve contractility when BP is too high to start nitroglycerin?

Answer 24

catecholamine class (dobutamine, dopamine, norepi)–only use these when absolutely necessary because they can causes cardiac ischemia and tachydysrhythmias