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Flashcards in acute decompensated HF Deck (20):
1

3 things stroke volume is a function of

1. preload
2. afterload
3. contactility

2

what happens in decompensation

tenuous balance with chronic LV changes, then something happens
1. incr. preload
2. incr. afterload
3. dec. contactipn

= RAPID onset of Sx of HF

3

what happens to lungs to case edema

1. LV has high fillingP and backs up
2. RV tries to cope by pushing forward even more

4

signs of HF

1. cough
2. SOB
3. edema
4. elevated JVP

5

4 patient profiles

1. dry and warm - healthy
2. dry and cold (low perf)
- sick, but compensated
3. wet and warm (congested)
- most common
4. wet and cold (low perf and congestion)
- bad shape

6

2 helpful tests

1. ECG
2. labs
- renal, leyte, CBC, troponin
- brain naturetic peptide (BNP)

7

what is BNP

released when ventricles are stretched

8

3 levels for BNP

500 - HF likely
** not useful if HF is obvious

9

3 tests in acute decomp. HF

1. CXR -high yield
2. echo - only if not done recently
3. heart cath - active ischemia

10

5 things to do to help stabilize

1. elevate bed
2. frequent vitals
3. O2 - monitor sats
4. IV access
5. PPV may help

11

5 durgs that improve hemodynamics and make ppl feel better

1. diuretics
2. morphine
3. digoxin
4. vasodilators
5. ionotropes

12

4 pearls for loop diuretics

1. IV furosomide best
2. high dose can worsen renal funct
3. resistance can occur
4. ototoxic at high doses

13

how do diuretics help

reduce end diastolic pressure

14

how does morphine help

1. pulmonary veno-dilator - reduces preload
2. reduces SNS activation
3. reduces dyspneaic sensation

15

pearls for digoxin

- incr. CA in myocyte
- weak effect in contraction
- incr. vagal tone and slows HR
- NARROW therapeutic index

16

what do vasodialtorsdo

nirto
- reduce after and pre-load

17

what are ionotropes (2)

1. B agonists
2. PDEis - milronone
- incr. contractility and less pre and afterload

18

**when not to use ionotrope

perfuse person

19

3 pearls to optimize med therp

1. initiate ACE and BB for LV dysfunciton when Pt is compensated
2. BP, renal, lytes should be monitored when titrating ACEi
3. start BB only when PT is stable and compensated

20

3 meds to aviod in decomp. HF

1. CCBs - negative ionotrope effects
2. anti-arryhtmics
3. NSAIDS - promote HT, Na retention

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