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CDM 2 Exam 2 > Lecture 2: Heart Failure > Flashcards

Lecture 2: Heart Failure Flashcards

1
Q

Signs that pt HF getting worse (self-monitoring)

A

Changes in breathing
Changes in weight
New or worse swelling
Changes in ability to do everyday things

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2
Q

How much should you limit sodium intake to for hf?

A

max of 2000mg a day

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3
Q

How much fluid restriction for a stage D patient?

A

1.5-2L per day reasonable to reduce congestion

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4
Q

ADHF defintion

A

New or worsening signs or symptoms of HF that are usually caused by volume overload and/or hypo perfusion and leads to additional medical care

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5
Q

ADHF effect on curve…

A

inc afterload

Dec contractility and HR

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6
Q

What happens in ADHF

A

Most likely (excessive neurohormone release)

  1. AT2 = vasoconstriction on rigid vessels (inc after load)
  2. Aldosterone = Na/H20 retention (inc preload)
  3. NE = sympathetic stim (A+B), inc renin release, attempt to inc contractility (b), increase HR
  4. Vasopressin = inc H20 retention, inc preload
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7
Q

3 groups of ADHF

A

De novo disease = 25%
Exacerbated symptoms = 70% (stage c)
advanced or end-stage = 5% (stage d)

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8
Q

Main treatment goals

A

improve congestion and low output symptoms quickly

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9
Q

Wet =

A

excessive volume

congestion
Distended internal JVD
SOB
Pulmonary Rales
Peripheral Edema
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10
Q

Dry =

A

Not wet

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11
Q

Warm =

A

Warm extremities
Normal urine & renal function
confusion

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12
Q

Cold =

A

cold extremities
Hypotension
Bluish lips/nail beds

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13
Q

Mean arterial pressure calculation

A

((DBP X 2) + SBP ) / 3

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14
Q

What do you want to titrate MAP to when starting therapy?

A

> 65

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15
Q

How much volume do you typically remove from patient per day?

A

1-2

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16
Q

How to calculate volume

A

water weight in lbs /2.2

17
Q

Drugs given in Warm & Wet stage

A

Diuretics
Vasodilators
NTG > Nitroprusside

18
Q

Drugs given in Cold & Dry stage

A

Fluid Admin

19
Q

Drugs given in Cold & Wet stage

A

Normal BP = Vasodilators

low BP = inotropic or vasopressors

20
Q

General idea…if congested you use..

A 
Diuretics
Vasodilators
Fluid Restrictions
Sodium Restriction
Compression devices to "move" fluid from tissues into vasculature

Need to reduce preload for heart to squeeze

21
Q

General idea….if low perfusion you use….

A

Inotrope
Inodilator
Pressors
Mechanical Devices

Need to stimulate “squeeze” and maintain BP

22
Q

Congestion Treatment w/ Diuretics dosing….

A

If pts already receiving loop diuretics, initial IV dose should be equal to or exceed the chronic oral daily dose and be given either Bolus or IV

23
Q

Adverse effects to consider with diuretics

A 
Hypokalemia
Hypomagnesemia
Uric Acid
Resistance
Reflex inc in neurohormones
24
Q

Why might Diuretics be ineffective in ADHF?

A

Compensatory inc in RAAS leading to fluid retention

Diuretic resistance due to distal tubule hypertrophy

pts w/ renal insufficiency or low albumin req higher doses

25
Q

If pt doesn’t respond to diuretics and congestion doesn’t improve, you can try to….

A

Restriction sodium to < 2g/d and fluids < 2l/day

inc dose of loop to max bolus dose

change to continuous IV

add second diuretic

ultrafiltration or Vasodilators

26
Q

Role for Vasodilators

A

Can release symptoms of dyspnea

NTG > nitroprusside

27
Q

Low perfusion treatments - inotropes….

A

Short term continuous IV inotrope support maybe reasonable in those hospitalized pts presenting w/ significant reduced cardiac output to maintain systemic perfusion and preserve end organ perfusion

28
Q

when giving Dobutamine or Milrinone

A

need to discontinue Beta-blockers

29
Q

Milrinone preferred when….

A

increased pulmonary artery pressure

Need for B-blockade

30
Q

Dobutamine preferred when…

A

Hypotension

Renal insufficiency

31
Q

Cardiogenic shock

A

persistant hypotension and tissue hypo perfusion due to cardiac dysfunction in presence of adequate vascular volume

32
Q

goals for Cardiogenic Shock

A

Maintain arterial pressure ( > 65) adequate for tissue perfusion

1st line = pressers

Norepie tends to be more balanced, Dopamine good ton too

33
Q

when is Norepi preferred over dopamine>

A

if high HR or arrhythmia concern

CDM 2 Exam 2 (16 decks)

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