Heart Failure Assessment Flashcards
What are symptoms of HF?
- dyspnea
- orthopnea (SOB when lying down)
- cough
- fatigue
- nausea/ poor appetite
- addition of pillows
What are signs of HF?
- pulmonary edema/ rales
- cool extremities
- cardiomegaly
- peripheral/ pitting edema
- venous stasis changes (increase varicose veins)
- s3 gallop heart sound
How are dyspnea, orthopnea, and peripheral edema managed?
loop diuretics
How are fatigue, cool extremities, and venous stasis managed?
increase cardiac output by increasing stroke volume with beta-blockers
What is synthesized and released from the ventricle due to pressure/ volume overload?
Brain Natriuretic Peptide (BNP)
What level of BNP is elevated?
> 100 BUT we need a baseline
What can cause a baseline BNP to be elevated?
renal failure / HF
How much does BNP need to be reduced for discharge?
decrease 3x
How is SCr affected by HF?
- decreased due to nutritional changes
- increased due to hypoperfusion (similar to pre-renal AKI)
What does hyponatremia indicate in HF?
volume overload and worse outcomes
An ejection fraction of ______ if HFrEF
<40%
An ejection fraction of _______ if HFpEF
> 60%
What NY Heart Classification would someone with no limitation to physical activity be?
I/A
What NY Heart Classification would someone with slight limitation (no breaks) to physical activity be?
II/ B
What NY Heart Classification would someone with marked limitation (breaks) to physical activity be?
III/C
What NY Heart Classification would someone with symptoms as rest be?
IV/D
When should Spirinolactone be initiated/ DC for HF?
Initiate: EF < 35% (HFrEF)
D/C: increased K+
When should ACE/ARBs be initiated/ DC for HF?
Initiated:
D/C: hypotension, angioedema, increased K+
When should Ivabradine be initiated/ DC for HF?
initiated: intolerant/ CI beta blocker AND normal sinus rhythm
D/C: not in normal sinus rhythmm
When should Sacubitril/ Valsartan (ENTRESTO) be initiated/ DC for HF?
initiated: all
D/C: increased K+, ACE washout
When should loop diuretics be initiated/ DC for HF?
initiated: volume overload
D/C: hypovolemia
When should SGLT2 (-) be initiated/ DC for HF?
initiated: all
D/C: DKA, hypovolemiamia
What beta-blockers show mortality benefits/ are approved for HFrEF?
Carvedilol
Metoprolol Succinate
Bisoprolol
What medications show mortality benefit is AAs with HFrEF?
Hydralazine
Isosorbide Dinitrate
What classes of medications show mortality benefits in HFrEF?
- ACE/ ARB/ Entresto
- Beta-blockers
- SGLT2 (-)
- Mineralcorticoid receptor antagonist
How long is the washout period when switching from an ACE to Entresto?
36 hours
Does a patient need a washout period when switching from ARB to Entresto?
No it does not affect bradykinin
What are adverse effects with hydralazine?
- SLE (hallmark)
- rebound tachycardia
- headache
