Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CV <3 > Lecture 14: Heart Failure 2 > Flashcards

Lecture 14: Heart Failure 2 Flashcards

1
Q

What is the rule of 2s?

A
  • No more than 2L of fluid a day
  • No more than 2g of sodium a day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the pharmacologic options for HF and what are their indications?

A
  • Congestion and edema = diuretics
  • SGLT2i = jardiance, farxgia, invokana, inpefa
  • HTN = ACEi, Thiazides, MRAs, ARNis, BBs (for htn, hr, and rate control)

MRA = mineral receptor antagonist like aldosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the only class I indication for symptomatic HFpEF? 2a?

A
  1. Class 1 = Diuretics
  2. Class 2a = SGLT2i
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most effective means of providing symptomatic relief for a HF patient?

A

Diuretics (lasix)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What must be monitored in diuretic therapy?

A
  • Renal function
  • Potassium
  • Weight changes

On average, every 20mg of lasix is countered with 10mEq of potasssium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Can you combine a thiazide with a loop?

A

Yes, but must be monitoring lytes and weight constantly.

Any change in diuretic should be monitored via a BMP in 1 week.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Does a patient need DM to be given SGLT2i in HF?

A

No. Helps with more natural diuresis to help with preload and afterload.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

AHA/ACC 2022 Guidelines for HFrEF

A

Everything is class I once you are stage C HF.

ARNis and ACEi/ARBs CANNOT OVERLAP (you can only use one of them)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What do you need to monitor when starting a ACEi?

A

BMP at 1-2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When are ARBs a class I indication for HFpEF?

A

Only when unable to tolerate an ACEi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the purpose of BBs and ACEi in HF?

A

Improving mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 3 BBs indicated in HF?

A
  • Metoprolol succinate (XL)
  • Bisoprolol
  • Carvedilol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What conditions make BB therapy more cautious?

A
  • Bradycardia
  • 1st degree AV block
  • Hx of asthma or symptomatic hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What do aldosterone antagonists do in terms of HF?

A
  • Prolong survival
  • Reduce cardiac remodeling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When are MRAs contraindicated in HF?

A

Potassium > 5 and GFR < 30.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is entresto?

A
  • Sacubitril/valsartan
  • Neprilysin inhibitor
  • An ARNi (angiotension receptor/neprilysin inhibitor)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does neprilysin do?

A

Limits breakdown of BNP and ANP.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When is entresto used?

ARNi

A
  • In place of ACEi/ARB
  • REQUIRES 36 hour washout period (must wait if you were on an ACEi)
  • Must be on appropriate ACEi and BB therapy already.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the main contraindication to entresto?

A

Angioedema with ACEi use.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When is hydralazine/nitrate therapy indicated for HF?

Isosorbide DInitrate + hydralazine

A

Class I for black patients that are ALREADY ON ACEi and BB therapy.

2a indication if non-black

Often prescribed separately due to cost.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does ivabradine/corlanor do?

A

Inhibition of funny channel in sinus node to slow the sinus rate.

2a indication for stable HF patients

Pacemaker current inhibitor (If)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the criteria to use corlanor/ivabradine?

A
  • HR >= 70
  • Sinus rhythm
  • Maximal BB therapy or unable to tolerate BBs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is digoxin’s primary use and indication class in HF?

A
  • Class 2b indication as addon therapy after ACEI/BB/MRA.
  • Improve HF symptoms and control ventricular rate in afib.

Not a titrated med, usually always 125mcg.

Primarily a negative inotrope.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What medications have debateable use in HF?

A
  • CCBs (amlodipine and felodipine only)
  • Verapamil and dilt ARE NOT TO BE USED
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What meds should be avoided in HF?

A
  • Antiarrhythmics (only use amiodarone or dofetilide)
  • NSAIDs
  • Thiazolidinediones (pioglitazone or rosiglitazone)
26
Q

When is cardiac rehab recommended?

A

Stable Class 2-3 NYHA

27
Q

When is CRT/cardiac resynchronization therapy recommended?

A
  • LVEF <= 35%
  • QRS > 120ms
  • NYHA Class 3 or 4 symptoms
28
Q

What kind of arrhythmias are common in HF?

A

Ventricular arrhythmias

29
Q

When is an ICD recommended as primary prevention for SCD?

A
  • Ischemic CM with LVEF <= 35% at class 2 or 3 NYHA and > 40d since MI or revascularization.
  • Non-ischemic CM with with LVEF <= 35% at class 2 or 3 NYHA and > 90d since dx with prognosis > 1year.
30
Q

When is an ICD used as secondary prevention?

A
  • HF and CM who have survived an episode of SCD or have sustained VT without obvious reversible causes.
  • Unexplained syncope with LVEF <= 30%
31
Q

What is the bridge therapy for ICD?

A

Lifevest

32
Q

What characterizes acute decompensated HF?

A
  • Acute dyspnea with rapid accumulation of fluid
  • Can be new HF or acute on chronic exacerbation
33
Q

How does acute decompensated HF present?

A
  • Acute pulmonary edema
  • Severe dyspnea
  • Production of pink, frothy sputum
  • Diaphoresis and cyanosis
  • Inspiratory rales is most common
34
Q

When is supplemental oxygen indicated for acute decompensated HF?

A

Only if needed.

Preferred method is NRB with high flow

35
Q

What is the mainstay therapy option for acute decompensated HF?

A

IV loop diuretics

30 minutes to have peak effect usually.

36
Q

What other system might be affected in acute decompensated HF?

A

Renal (cardiorenal syndrome), which may improve with diuresis.

Gotta balance between renal and cardio function.

Must monitor for if they had poor renal function to begin with or if its caused by the HF.

37
Q

If a patient in acute decompensated HF is not responding inadequately to diuretic therapy, what can we do?

A
  • Sodium restriction
  • Water restriction for hypoNa
  • Add 2nd diuretic (chlorthiazide, HCTZ, metolazone, MRAs)
38
Q

What vasodilators are used for acute decompensated HF?

A
  • IV ntg, nitroprusside, or morphine

Monitor BP VERY CAREFULLY

Usually will be an ICU patient with a-line BP monitoring

39
Q

What does ntg do in moderate and high doses?

A
  • Normal: Reduce LV filling pressures via venodilation
  • High: Lowers systemic afterload
40
Q

When is nitroprusside used and what are the risks?

A
  • Pronounced afterload reduction needed
  • Risks: Cyanide poisoning, reflex tachycardia, rebound vasoconstriction, only use for 1-2 days MAX.
41
Q

What is morphine good for?

A
  • Pulmonary edema
  • Pain
  • Systemic vasodilation
  • Lower LA pressure
  • Anxiolytic
42
Q

What is nesiritide?

A

Recombinant BNP with long half-life that is not preferred.

43
Q

When are ACEis used in acute decompensated HF?

A

Stable therapy for post-discharge.

44
Q

When should BBs not be used in acute decompensated HF?

A

Hold if they are on chronic BB therapy and severely decompensated or hypotensive

Otherwise, start after stable.

45
Q

What are the two inotropic agents used in acute decompensated HF?

A
  • Milrinone: PDE3 inihibitor that can also cause vasodilation
  • Dobutamine: B1 agonist to increased BP, HR, and some vasodilation.
  • Only used for severe LV dysfunction.

Milrinone can cause hypotension.
Dobutamine can cause HTN.
Per UTD, dobutamine is generally preferred unless the pt was recently on a BB.

46
Q

When is VTE prophylaxis used?

A
  • Hospitalized patients with ADHF.
  • Give heparin/lovenox/fondaparinux
  • SCDs used if can’t use A/C

SCDs = sequential compression devices on calves to squeeze

47
Q

What is CRRT/ultrafiltration and what is it used for?

A
  • Continuous renal replacement therapy
  • Remove excess fluid without causing hemodynamic compromise or lyte changes
47
Q

When is mechanical cardiac assistance used in ADHF?

A

Cardiogenic shock with poor CI (cardiac index), low systolic BP, and elevated PCWP

48
Q

What are the two devices used for mechanical cardiac assistance?

A
  • Intraaortic balloon pump (counterpulsation)
  • Internally implanted LVAD
49
Q

What hemodynamic findings suggest cardiogenic shock?

A
  • Hypotension
  • PCWP > 15
  • CI < 2.2
50
Q

Define cardiac index?

A

CO proportional to body surface area (BSA)

Normal CI is 2.6-4.2

51
Q

What does the classic cardiogenic shock patient look like?

A

Cool, clammy, moist skin with tachycardia

52
Q

What are the two primary things a swan ganz measures?

A
  • PCWP
  • Estimates LA pressure
53
Q

What do positive inotropes/pressors do?

A
  • Increased contractility
  • Increased HR
  • Increased peripheral vascular tone

Very potent. Often given in large bore central IVs to prevent systemic.

54
Q

How does dopamine’s effect vary on its dosage?

A
  1. Low: dilation of renal arterioles
  2. Intermediate: B1 agonist and contractility
  3. High: alpha agonist + B1 agonist
55
Q

What is the difference between dobutamine and dopamine?

A

Dobutamine has no renal effect and is much more B2-agonist focused.

B2 = arteriolar vasodilation.

56
Q

What does levophed/NorEpi do?

A
  • Increased CO and HR
  • Decreased renal perfusion
  • Emailed mellert asking why peripheral vascular resistance is decreased with levophed?

Generally used to boost BP if dopamine alone is not enough.

57
Q

What is an IABP used for? LVAD?

Intra-aortic balloon pump

A
  • IABP: Temporary support and requires AC. Decreases afterload without increasing myocardial demand.
  • LVAD: bridge to transplant therapy
58
Q

What does presence of S3 suggest?

A

Diminished systolic function

S3 presence would mean fluid from the LA is hitting the leftover fluid in the LV during diastole.

S3 occurs during early diastole.

59
Q

Simplified Inotrope/Pressor guide

A

CV <3 (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions