12- CHF

Question 1

2 cats of CHF

Answer 1

systolic - dilated LV with poor contractility

diastolic - stiff LV with poor filling

Question 2

causes of CHF (8)

Answer 2

1. CAD
2. HT
3. valve disease
4. cardiomyopathy
5. percardial disease
6. metabolic
7. viral
8. toxins

Question 3

5 general cats. of CHF precipitants

Answer 3

1. cardiac
2. meds, nsids, neg ionotropes, BB
3. diet - salt
4. high output
5. other
   - HT crisis, renal failure

Question 4

Sx of CHF

Answer 4

• dyspnea
• orthopnea
• PND
• cough, wheeze
• fatigue
• lower limb edema

Question 5

signs of CHF

Answer 5

• tachynea/cardia, HT or hypo
• crackles, wheeze
• S3,S4
• JVP high
• hepatomegaly
• edema
• weak peripheral pulses

Question 6

investigations for CHF

Answer 6

1. CXR
   - more useful
2. ECG
   - LV hypertrophy, LA abnormal
3. trops
   - if due to an MI, but can also increase without MI
4. ECHO
   - look at LV size and movement
5. natuetic peptides
   - useful to rule in after CXR
6. renal function
   - prognositic of poor outcome in CHF
7. Sodium
   - hyponatremia common
8. Coronary angio
   - in acute
9. Swan ganz- cath
   - not routine

Question 7

General MGMT

Answer 7

• ABC
• place upright
• 100 O2
• montiros
• IVs
• foley
• diuresis
• vasodilator

Question 8

2 first line drugs

Answer 8

1. furosemide

2. Nitroglycerin

Question 9

what to do if no response

Answer 9

1. double furosemide
2. nitro infusion
3. if less LOC - intubate
4. if BP

Question 10

2 uses of nitro

Answer 10

• reduce preload and some afterload

- reduce ischemia

Question 11

what ionotropes to use

Answer 11

dobutamine
- for those wtihout shock
mironone
- increase ionotropy
dopamine
- for shock

Question 12

when to use diltiazem

Answer 12

when a fib is also present

Question 13

4 adjunct therapies

Answer 13

1. CPAP or BiPAP
   - helps in crease intrathoracic pressure
2. intubation
   - if failing to oxygenate
3. ultrafiltration
   - alternate to remove fluid
4. mechanical cardiac assisstance
   - for severe with shock

Question 14

4 meds NOT used

Answer 14

1. digoxin
   - for chronic
2. BB
   - chronic
3. ACEi and ARB
   - chronic
4. morphine
   - may cause resp distress - caution

Question 15

3 best predictors of mortality

Answer 15

1. high BUN
2. low SBP
3. high creatinine