Foundations II (Cholley) > CHF > Flashcards

CHF Flashcards

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1
Q

What causes serum Na abnormalities?

A

Changes in TBW

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2
Q

Rapid shifts in osmolarity lead to what?

A

Change in cell volume

- Can induce seizures

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3
Q

ADH is secreted in response to what?

A
  • Hyperosmolarity
  • ↓effective arterial volume
  • Angiotensin II
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4
Q

Aldosterone

A

Regulates total body Na & therefore volume

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5
Q

Aldosterone is secreted in response to what?

A

Hypovolemia via renin & angiotensin II

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6
Q

What does ADH cause?

A

Insertion of aquaporin channels into collecting ducts –> H2O reabsorption

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7
Q

Define CHF

A

Inability of the heart to pump in proportion to the metabolic demands of the body

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8
Q

What does CHF lead to?

A

Usually a hypervolemic state

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9
Q

What is the most common cause of hospitalization for pts aged 65 & older?

A

CHF

- Primarily a disease of aging

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10
Q

CHF risk factors

A 
Obesity
Obstructive sleep apnea
Smoking
Pregnancy
Infection
Diabetes
Physical inactivity
Renal insufficiency
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11
Q

What are the 4 major determinants of CO?

A
  1. Contractility
  2. Preload
  3. Afterload
  4. HR
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12
Q

What can increase afterload?

A
  • HTN
  • AS
  • Coarctation of aorta
  • Atherosclerosis
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13
Q

Systolic HF

A
  • LV EF is reduced

- Results in eccentric remodeling

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14
Q

Diastolic HF

A
  • LV systolic fxn is typically preserved
  • Altered ventricular compliance –> high filling pressure
  • Results in concentric remodeling
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15
Q

What is the #1 cause of systolic HF?

A

Ischemia

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16
Q

Systolic HF

A

CAD w/ MI

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17
Q

What is the #2 cause of systolic HF?

A

HTN

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18
Q

Diastolic HF

A

Abnormal diastolic relaxation or ventricle filling

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19
Q

Cardiomyopathies

A

Dilated & hypertrophic

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20
Q

Causes of cardiomyopathies

A
  • Ischemic vs non-ischemic
  • Genetic/familial
  • HTN
  • Hemochromatosis
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21
Q

Most common cause of R sided HF is what?

A

L sided HF

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22
Q

Other causes of RV failure

A
  • Pulmonary embolism
  • Endocarditis
  • Toxic substances & illicit drugs
  • Myocarditis
  • COPD
  • Pulmonary HTN
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23
Q

Acute HF causes

A
  • MI
  • Rupture of intraventricular septum
  • Acute valvular incompetence
  • Pulmonary embolism
  • Cardiac tamponade
  • Fulminant myocarditis

*Require immediate dx & tx

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24
Q

What causes high output HF?

A
  • Pregnancy
  • Anemia
  • Thyrotoxicosis
  • Beriberi
  • Paget’s disease
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25
Stage A
- At high risk w/o structural disease or sx | - Ex. HTN
26
Stage B
Structural disease but w/out sx
27
Stage C
Structural heart disease w/ prior or current sx
28
Stage D
Refractory HF, requiring interventions
29
NYHA classification
- I: Asymptomatic - II: Sx w/ moderate exertion - III: Sx w/ mild exertion - IV: Sx at rest
30
LV failure signs & sx
Low CO & elevated venous pressure: - Fatigue - Dyspnea - Weight gain - Crackles - Elevated jugular venous pressure - Edema - Paroxysmal nocturnal dyspnea
31
What is the #1 sx seen in RV failure?
Edema
32
What is hepatojugular reflux associated w/?
Both L-sided & R-sided HF
33
Hepatojugular reflux procedure
1. Firm, yet gentle, compression applied to RUQ for 1 min 2. Advise pt to breath normally 3. Observe neck vv 4. JVP should rise or fall 4cm after pressure released
34
What is specific on PE for CHF in middle-aged & older adults?
S3 gallop
35
What may be heard in diastolic failure & what does it imply?
S4 gallop | - Implies noncompliant ventricle
36
Dx studies
- CBC (anemia) - CMP - BNP - Thyroid fxn - Iron studies - EKG (acute vs chronic changes) - Pulse oximetry - ABG - PEFR - CXR (cardiomegaly) - Echo - Cardiac cath
37
BNP (definition & what does it reflect?)
- Hormone released from heart in response to ventricular volume expansion & pressure overload - May reflect severity of CHF
38
BNP < 100
CHF can be excluded
39
BNP 100-400
Inconclusive
40
BNP > 400
Consistent w/ CHF
41
EKG, acute vs chronic changes
- Acute (AMI, dysrhythmia, pulmonary embolism) - Chronic (LVH, old MI) - 25% have conduction abnormality (most common = LBBB)
42
Pulse oximetry
Noninvasive estimate of O2 saturation | - optimal = > 92%
43
ABG
Mild hypoxia, hypocarbia, & respiratory alkalosis occur early in CHF
44
What implies critical CHF?
Worsening PaO2 & metabolic acidosis
45
What helps distinguish early CHF from COPD?
Peak Expiratory Flow Rate (PEFR) - > 150 = acute CHF - < 150 = COPD
46
A normal size heart w/ CHF on CXR may suggest what?
acute MI, constrictive pericarditis, or mitral stenosis
47
Echo
Most useful tool for evaluating: - Etiology of CHF - Extent of CHF (EF)
48
Cardiac catherization
Direct measurement of ventricular diastolic pressure - Demonstrates impaired relaxation & filling - Ruleout CAD & valvular heart disease
49
Goals of tx
1. improve QOL 2. improve cardiac fxn when possible 3. reduce risk of death
50
Optimal therapy
Combination of: - Multiple meds & non-drug tx - Lifestyle changes - Electrophysiologic & surgical therapies
51
Lifestyle changes
- carbs & caloric restriction - caloric supplementation - restriction of Na & fluid intake - support stockings - multivitamin - exercise - smoking cessation - limit alcohol - avoid NSAIDS - CPAP
52
What vaccines should pts w/ HF receive?
- Pneumococcal | - Influenza
53
What is the initial pharmacologic tx in MOST pts w/ sx?
Combo of diuretic & ACE
54
What medication should be avoided?
Ca channel blockers | - Can worsen CHF w/ chronic use
55
Beta blockers
Protect from SNS overstimulation - Should be avoided in: Heart block, bradycardia, severe bronchospasm, & dyspnea at rest
56
Diuretics
- Decrease preload - Provide sx relief - Frequent monitoring of renal fxn, dehydration, & electrolytes needed
57
Loop diuretics
- Useful in patients w/ more severe CHF - Used IV in acute setting - Furosemide produces prompt venodilation & diuresis
58
Adverse rxns of loop diuretics
- intravascular volume depletion - hypotension - hypokalemia (increases digoxin action)
59
When are K+ sparing agents indicated?
In pts who have: - NYHA class III or IV w/ LV dysfunction OR - Had an acute MI & sx of HF & LVEF < 40%
60
Examples of K+ sparing agents
- Spironolactone (Aldactone) 25mg PO qd - Triamterene (Dyrenium) 100mg PO bid - Amiloride (Midamor) 5-10mg PO qd
61
What is the fxn of K+ sparing agents?
- Prevent remodeling of the heart due to catecholamines - Inhibit RAAS system - Can be used w/ loop & thiazide
62
Fxn of spironolactone
Mediates some of the major effects of the RAAS system: - Myocardial remodeling - Fibrosis - Na retention & K+ loss * Should monitor for hyperkalemia
63
What do ACE-I cause?
Vascular dilation --> decrease in both preload & afterload
64
What are ACE-I associated w/?
Decreased mortality & improved status in those w/ systolic HF
65
How do you prevent hypotension in those taking ACE?
- Initiate at low dose | - Titrate up if tolerated
66
ACE contraindications
- Renal insufficiency - Bilateral renal artery stenosis - Hyperkalemia - Symptomatic hypotension - Hx of adverse rxns
67
Fxn of ARBs
Block A-II type 1 (AT) receptor (potent vasoconstrictors that may contribute to the impairment of LV fxn)
68
Fxn of Neprilysin (ARNI)
Degrades natriuretic peptides
69
Another example of ARNI
Sacubitril-valsartan (Entresto)
70
What do beta blockers reduce?
Hospitalizations, sudden death, & mortality in CHF
71
Examples of beta blockers
- Carvedilol - Metoprolol succinate - Bisoprolol
72
Beta blockers precautions
``` Hypoglycemia Asthma Resting limb ischemic pain Bradycardia Hypotension ```
73
Digoxin
- Does not improve survival, but does improve sx & decrease hospitalizations - Increases CO - Inhibits Na/K/ATPase pump
74
Direct vasodilating drugs (hydralazine, isosorbide)
Reduce systemic vascular resistance & venous pressure (afterload) *Consider in black pts!
75
Nitrates
- Type of vasodilator | - Relieves SOB
76
Example of nitrates
Nitroglycerin | - Reduces preload
77
Sodium nitroprusside (Nitropress)
- Potent dilator of arteriolar resistance & venous capacitance - Increases CO, decreases ventricular filling pressures
78
Fxn of ICDs
- Monitor HR & rhythm | - Correct arrhythmias
79
Who qualifies for an ICD?
- Pt w/ previous MI & EF < 30% - Pt w/ EF < 35% & NYHA II/III - Pt whose life expectancy exceeds 1 yr
80
Who qualifies for a biventricular pacemaker?
Symptomatic pts w/ NYHA III or IV w/ EF < 35% & QRS > 130 despite max therapy
Foundations II (Cholley)
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