Heart Failure Flashcards
What 3 compensations are made in heart failure?
increased preload, increased afterload, increased contractility
What does low cardiac output and increased afterload do to renal perfusion?
decreases it
What does a decrease in renal perfusion cause?
fluid and sodium retention
What results from elevations in preload (volume overload)?
ventricular dilatation
Acute exacerbations of CHF results in what?
poor cardiac function and fluid accumulation in the lung with hypoxia
What causes low-output HF?
primary heart disease like coronary artery disease, severe hypertension, valve disease, cardiomyopathy, dysrhythmias
What causes high-output HF?
increase metabolic demands like thyrotoxicosis, severe anemia, AV fistula, Beriberi (thiamine deficiency), paget’s disease
What are clinical features of left heart failure?
dyspnea, orthopnea, PND, weakness, fatigue, tachycardia, S3, rales
What are the clinical features of right heart failure?
JVD, peripheral edema, RUQ pain, hepatojugular reflux, hepatomegaly, ascites
What labs could be abnormal in HF?
anemia, renal insufficiency, elevated LFTs, hyponatremia (due to fluid overload diluting sodium)
What specific lab study will be elevated in HF?
BNP
What will CXR show in HF?
cardiomegaly, cephalization, kerley B lines, alveolar fluid, pleural effusions
What is done to manage chronic HF?
exercise, low-sodium diet, manage hypertension
Which meds decrease preload?
nitrates and diuretics (loop or thiazide)
What med decreases afterload?
ACE inhibitors–improve cardiac output and improve renal perfusion
What med decreases catecholamine levels (decreasing afterload) and helps with dysrhythmias?
beta-blockers
What are the two most important anti-hypertensives to use in chronic HF?
ACE inhibitors and beta-blockers
When patients with chronic HF have low ejection fraction what should they be on?
anti-coagulants
What physiological causes account for acute decompensated HF?
increased preload, increased afterload or decrease left ventricular function
What should be done initially in acutely decompensated HF?
100% O2-bipap or cpap is fine
If the acutely decompensated HF patient needs to be intubated what should be added on the vent?
positive end-expiratory pressure (PEEP)
In acutely decompensated HF what should be used to decrease preload?
nitroglycerin is best but loop diuretics can be used too
In acutely decompensated HF what should be used to decrease afterload?
nitroglycerin works for this too but you can use ACE inhibitors too
In acutely decompensated HF what should be used to improve contractility when BP is too high to start nitroglycerin?
catecholamine class (dobutamine, dopamine, norepi)–only use these when absolutely necessary because they can causes cardiac ischemia and tachydysrhythmias
