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Flashcards in 12- CHF Deck (15)
1

2 cats of CHF

systolic - dilated LV with poor contractility
diastolic - stiff LV with poor filling

2

causes of CHF (8)

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

3

5 general cats. of CHF precipitants

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

4

Sx of CHF

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

5

signs of CHF

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

6

investigations for CHF

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

7

General MGMT

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

8

2 first line drugs

1. furosemide
2. Nitroglycerin

9

what to do if no response

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

10

2 uses of nitro

- reduce preload and some afterload
- reduce ischemia

11

what ionotropes to use

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

12

when to use diltiazem

when a fib is also present

13

4 adjunct therapies

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

14

4 meds NOT used

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

15

3 best predictors of mortality

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