HF Flashcards
Core measures include per Joint commission
- ACEI/ARB
- LV assessment
- Smoking cessation
- D/C instructions
Performance measure goal
To improve quality of life
Discharge instructions, what percentage of reduction of mortality, and hospital Readmission 
10% and 25%
In the setting of hyponatremia, what dose spiralactone to be initiated? 
12.5 mg
How many days to stop SGLT2 prior to surgery?
3 days
Three types of MRA
Spirolactone
Eplerenone
Finerenone
How does nonselective aldosterone, receptive agonist work?
Works on minerolocorticoid receptors in the heart, brain, kidney, blood vessel, and androgen receptor in breast and ED 
Absolute contraindication for heart transplant, (six)
- Systemic illness with life expectancy less than two years
- Reversible pulmonary hypertension. (PVD >3Wu)
- Severe, symptomatic, cardiovascular disease.
- Active substance abuse.
- Inability to comply with drug therapy.
- Disease with severe extracardiac dysfunction.
Relative contraindication for cardiac transplant(10)
- Age.>70
- Obesity BMI.> 35.
- Poorly controlled diabetes
- Irreversible renal dysfunction GFR <30
- Neoplasm infection
- Acute PE
- Tobacco. Use within six months.
- Substance abuse, within six months.
- Lack of social support.
- PVD.
LVAD goals
Destination therapy
Bridge to recovery
Bridge to decision
I NEED HELP
Inotrope
NYHA III
End organ dysfunction
Edema despite diuretic
Defibrillator shocks
Hospitalizarion >1
EF <30
Low BP
Prognostic meds GDMT
Indications for cardiac biopsy (8)
- <2 weeks duration with normal sized or dilated LV with hemodynamic compromise
- 2 weeks to 3 months duration associated with dilated LV, and new ventricular arrhythmia, third-degree block.
- Any Duration of HF associated with suspected allergic reaction and eosinophilia
- Suspected on recycling cardiopathy if the cause of cardiac dysfunction is uncertain.
- And explained restrictive cardiomyopathy
- Cardiac tumors, where the need for surgical intervention is undetermined.
- Unexplained, ventricular hypertrophy, if an infiltrative or storage disease is suspected, and other evaluation is inconclusive.
- Suspected arrhthmogenic RV CMP if other evaluation is inconclusive 
On 6 min walk what is the distance that suggests death or hospitalization within 6 month
<300 ft
When to refer for advanced therapy (9)
- Exercise intolerance.
- Unintentional weight loss.
- Refractory volume overload.
- Recurrent ventricular arrhythmias
- Hypotension.
- Signs of inadequate perfusion
- CI <2.2 despite optimal medical therapy.
- Less than 300 feet on six minute walk
- Peak V02 <12
Criteria for advanced HF (4)
- Severe and persistent symptoms of HF , class 3 or 4
- Severe cardiac dysfunction.
- Hospitalization or unplanned visit in 12 months
- Severe exercise capacity
Criteria for cardiac dysfunction (5)
- EF <30
- Isolated RV dysfxn
- Nonoperable severe valve abnormality
- Nonoperable severe congenital heart disease.
- EF >40, elevated nateic peptide level and significant DD
Absolutely contradication for LVAD (5)
- Irreversible hepatic dz
- Irreversible renal dz
- Irreversible neurological dz
- Medical non adherence
- Severe psychosocial limitations
Relative contraindication for LVAD (10)
- Age 80
- Obesity or malnutrition.
- Muscular disease (limiting rehab)
- Active systemic infection
- Untreated, malignancy
- Severe PVD
- Active substance-abuse.
- Impaired cognitive function.
- Unmanage psychiatric disorder.
- Lack of social support.
Electrolyte causes for Dig toxicity
- Hypokalemia
- Heypercalcemia
- Hypomagnesemia
Signs of low flow cardiogenic shock (8)
- Narrow pulse pressure
- Cool extremities
- Lethargic
- Hypotensive
- Renal failure
- Pulses alternate
- Low Na
- Lactic acidosis
Defination of Pacer induced CMP
Drop of EF by 10% since pacer implanted
Who is at risk for pacer induced CMP (3)
- RV pacing >40% or PVC burden >12%
- Native QRS >150ms
- Paced QRS >150ms
Four types /class of diuretics
- Loop
- Thiazide
- Carbonic anhydrase inhibitor
- Potassium sparing
Example of carbonic anhydrase inhibitor
Diamox (acetazolamide)
Mechanism of carbonic anhydrase inhibitor and target site
Proximal tubule - decreases Na and bicarb reabsorption
Examples of loop diuretics
Lasix
Bumex
Torsemide
Target site and mechanismnof loop diuretic
Loop of Henle - excrets Na, water, chloride, Ca, K, Mg
Example of potassium sparing (4)
Spironoloctone
Triamterene
Eplerenone
Finerenone
Target site and mechanism of potasium sparing
Late distal tubule plus collecting duct - inhibit aldostrone activity by binding to aldosterone receptors
Examples of thiazides
HCTZ
Chlorothiazide (Diuril)
Chlothalidone
Metalazone (Zaroxolyn)
Target site and mechanism of thiazides
Distal convoluted tubule - decreases Na reabsor. by increasing Na and water excretion
Conversion Lasix to Torsemide to Bumex
Bumetanide 1mg is equivalent to furosemide 40mg (oral), furosemide 20mg (IV), and torsemide 10-20mg
Criteria for hospital discharge (8)
- Exacerbating factors addressed
- Near optimal volume status
- Transition from IV to oral diuretic
- Patient and family education completed
- LVEF documented
- Smoking session canceled
- Near optimal pharmacologic therapy achieved
- Follow up clinic visit scheduled 
Discharge criteria for advanced HF (5)
- Oral medication regimen stable for 24 hours
- No IV vasodilator or inotopic for 24hrs
- Ambulation before discharge
- Plans for post discharge management
- Referral to disease management, if available

Mechanism of action for Entresto
Promote diuresis, vasodilation and Na excretion
