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Cardio Exam 2 Remediation > Heart Failure II > Flashcards

Heart Failure II Flashcards

1
Q

BNP and NT pro-BNP levels at which to get an echo if the presentation fits

A

Nt-proBNP - 125+
BNP - 35+

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2
Q

Class I recommendations

A

Is recommended/Indicated
Negligent if not done

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3
Q

Class IIa recommendations

A

Should be considered - weight of evidence seems to suggest efficacy but no clear consensus

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4
Q

Class IIb recommendations

A

May be considered - efficacy is less well established

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5
Q

Class III recomendations

A

Evidence is against giving - not recommended

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6
Q

Lifestyle modifications of HFpEF - rule of twos

A

Sodium restriction of 2g/day
Restrict to 2 Liters of water/day
2 lbs. weight gain/week - concerning

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7
Q

Class I pharm indication for a patient with HFpEF

A

Thiazide or Loop Diuretics

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8
Q

Three Thiazide diuretics

A

Hydrochlorothiazide, Metolazone (Very potent), Chlorthalidone (IV)

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9
Q

2 things to check when putting a patient on a diuretic

A

Potassium and renal function

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10
Q

Potassium replacement for lasix

A

10mEq of K for 20mg of Lasix

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11
Q

Monitoring for diuresis

A

Daily weights
Keep track of lifestyle modification
BMP within a week of initiation to assess kidney function

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12
Q

Class IIa recommendations for HFpEF

A

SGLT2 inhibitors -gliflozin, Jardiance, Farxiga

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13
Q

Class IIb recomandations for HFpEF (3)

A

ARNi - Entresto
Aldosterone antagonist - Spironolactone, Eplerenone
ARB -sartan

Greater benefit if LVEF closer to 50%

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14
Q

5 lifestyle modifications for HFrEF

A

Tobacco and alcohol cessation
Sodium restriction
Daily weight monitoring
Weight loss in obese patients
Increase Exercise/Cardiac rehab

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15
Q

6 First line, class I recommendations for patients with HFrEF in stage C

A

ARNi in NYHA II-III
ACE OR ARB in NYHA II-IV
Beta blocker
Aldosterone antagonist
SGLT 2 inhibitor
Diuretics as needed

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16
Q

Condition to add second line therapy for HFrEF

A

Persistent HFrEF less than or equal to 40%

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16
Q

Condition to begin first line therapy for HFrEF

A

ACA/AHA Class C!!

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17
Q

Second line class I recommendation for African American patients in stage III-IV HFrEF

A

Hydral-nitrates - Hydralazine+Nitrates

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18
Q

Second line class I recommendation for NYHA I-III patients with HFrEF under 35% (more than 1 year survival)

A

Implantable cardioverter defibrillator

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19
Q

Second line, class I recommendation for NYHA II-III, Ambulatory IV, LVEF 35% or less
NSR and QRS 150+ with LBBB

A

Cardiac Resynchronization therapy

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20
Q

3 Class I, 3rd Line recommendations for refractory HFrEF

A

Mechanical circulatory support
Cardiac transplant
Palliative care (can be initiated before stage D)

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21
Q

3 ACEi’s for HFrEF

A

Enalapril, Captopril, Lisinopril
Take baseline K and Renal fxn, then in 2 weeks

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22
Q

ARBS for HFrEF - One condition and 3 recommendatons

A

Only if they cannot tolerate ACEi (angioedema, cough)
IIa - Keep on ARB if already on one at dx
IIb - Add to ACE if Aldosterone Antagonist is CI
III - Add to ACEi and Aldosterone Antagonist

23
Q

3 BBs for HF

A

Carveidolol
Metoprolol Succinate (stays)
Bisoprolol
OTHERS NOT FOR HF
Caution with asthma

24
Q

CI for aldosterone antagonists

A

Potassium over 5 and eGFR under 30

25
Q

Entresto

A

Sacubatril and Valsartan
Limits breakdown of ANP and BNP
Used in place of ACEi - Need 36 hour washout period
CI in patients who have had angioedema with an ACEi

26
Q

Hydralazine Nitrates for HFrEF

A

Second line
In addition to ACE and BB
Class I in black patients
Class IIa as replacement for ACE/ARB d/t intolerance or renal failure

Hydralazine and Isosorbide Dinitrate

27
Q

Ivabradine (Corlanor)
MOA and One rec with 3 criteria

A

Works on SINUS node
Class IIa recommendation if:
Sinus rhythm
HR 70+ bpm
Maxed on BB or CI for BB (severe asthma)

28
Q

Digoxin

A

Class IIb indication
If maxed out on everything else

29
Q

CCBs in HFrEF

A

NO VERAPAMIL or DILTAEZEM
Amlodipine and Felodipine are GOOD

30
Q

3 Medications to AVOID in HFrEF

A

Antiarrythmics
NSAIDs - chronic use
Thiazolidinediones (~glitazone)

31
Q

NYHA classes to send to cardiac rehab

A

Class II or III

32
Q

Cardiac resynchronization therapy

A

3rd line class I recommendation
For QRS over 120ms
NYHA III-IV Symptoms

33
Q

Conditions for ICD placement for primary prevention of sudden cardiac death

A

LVEF 35% or less
NYHA class II or III
1+ year survival likelihood
HF symptoms for 40 days if d/t ischemia
HF symptoms for 90 days w/o ischemia

34
Q

Conditions for ICD placement for secondary prevention

A

Implant immediately if SCA or sustained V-Tach
Implant immediately if unexplained syncope with LVEF 30% of less

35
Q

Life-Vest for SCA prevention

A

Use while waiting to fulfill primary prevention criteria for ICD

36
Q

Acute decompensated heart failure

A

Happens fast and can kill the patient
May be because patient stops meds or eats too much salt
May be tachyarrhythmia or MI

37
Q

Presentation of acute decompensated HF

A

Pink frothy sputum
Sweaty - Ill appearing
Cyanosis
Rales
SOB, difficulty ambulating d/t SOB

38
Q

Diagnostics for acute decompensated HF

A

EKG - For Cause
Echo, CXR, BNP, CMP, Cardiac enzymes, CBC

39
Q

Management of ADHF

A

Airway/Oxygenation assessment
Vital signs
Cardiac monitoring
IV diuretics
Vasodilator
I/O monitoring

40
Q

When to oxygenate

A

O2 sat is 94% or less

41
Q

Diuretics for ADHF

A

Loop diuretics!!

42
Q

Recourse in inadequate response to diuretic therapy in ADHF

A

Chlorothiazide IV
HCTZ
Metolazone
Aldosterone antagonist
Sodium restriction
Water restriction
Second diuretic

43
Q

Vasodilators in ADHF

A

Only if BP is high - watch for what Lasix might do to BP
Nitroglycerin (esp. b/c they might be having an MI)

44
Q

Morphine in ADHF

A

Helps vasodilate and and highly effective in reducing pulmonary edema
May decrease ventilatory drive

45
Q

Natrecor

A

Recombinant BNP - not very effective

46
Q

ACE/ARB BB for ADHF

A

Give once stable!!
BB CI in ADHF because we need the heart beating
NO BETA BLOCKER IN ANY ACUTE HEART FAILURE

47
Q

Inotropic agents for ADHF

A

Milrinone and Dobutamine
Indicated for severe LV systolic dysfunction
Both can vasodilate
Hypotension w/ Milrinone
Hypertension w/ Dobutamine
Last ditch effort

48
Q

Additional therapy for ADHF

A

Anti-coagulation/SCDs
Ultrafiltration to draw off fluid
Mechanical Cardiac Assistance
BiPAP

49
Q

Hemodynamic findings of cardiogenic shock

A

Hypotension
Pulmonary Capillary Wedge Pressure over 15mmHg
Cardiac index under 2.2L/min/m2

50
Q

Cardiac index

A

Cardiac output per minute per square meter of body surface area
2.6-4.2 is normal

CO/Body Surface Area

51
Q

Presentation of cardiogenic shock

A

Mottled and pale
Hypotensive and tachycardic

52
Q

Management of Cardiogenic shock

A

Cardiac enzymes
Coagulation
Anion gap
BNP
EKG
Stat Echo
CXR
Foley catheter
Pulmonary Artery catheter
Left heart cath
Similar to ADHF

53
Q

Pulmonary wedge pressure

A

Indirect measurement of Left Atrial Pressure
Normally 8 to 10 mmHg

54
Q

Inotropic agents for cardiogenic shock

A

Can cause the patient to loos fingers/toes
Push into LARGE vessels
Dopamine
Dobutamine
Norepinephrine
LAST RESORT
Start;Max;Add

55
Q

Additional place to check for edema - one in women and one in men

A

Scrotal - men
Coccygeal - Women

Cardio Exam 2 Remediation (7 decks)

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