Acute Heart Failure

Question 1

Low perfusion at rest =

Answer 1

cold

Question 1

in Cold and Wet, diuresis will improve

Answer 1

cardiac output

Question 1

ionotropic drugs if

Answer 1

cold and dry

cold and wet and normal SVR

Question 1

most patients iwith acute decomp HF fall into this category

Answer 1

wet and warm

Question 2

impact on cardiac oxygen consumption milrinone

Answer 2

not significant

Question 4

risks of increased calcium with ionotropes

Answer 4

arrhythmias

Question 5

limitations of nitroprusside

Answer 5

cynaide toxicity -nausea, weird (if low hepatic perfusion)

accumulation of thiocynate (esp if impaired renal fxn)

Question 6

diuresis not possible if

Answer 6

renal perfusion impaired

Question 7

considered a inodilator because ionotrope and vasodilator (cAMP changes lead to relaxation)

Answer 7

milrinone

Question 7

diuretic side effects

Answer 7

electrolyte abnml

hypotension

gout exacerbation

hearing loss

Digoxin toxicity

renal insuf

muscle cramps (if too rapid)

Question 9

impact of hypervolemia on CVP

Answer 9

increases CVP

Question 9

healthy perfusion at rest =

Answer 9

warm

Question 9

warm vs cold

cardiac index

Answer 9

cardiac index >2.2 = warm

Question 9

side effects milrinone

Answer 9

hypotension

arrhythmia

tachycardia

Question 10

congestion at rest =

Answer 10

wet

Question 11

challenges of diuretics

Answer 11

braking - long term tolerance of natriretic response

rebound may lead to Na retention

long term tolerance due to tubular hypertrophy

Question 12

Cl levels cold/wet/dry/warm

Answer 12

Warm/Dry - Cl normal

Warm/Wet - Cl normal

Cold Dry - Cl decreased

Cold/wet - Cl decreased

Question 12

impact on mortality, diuretics

Answer 12

no improvement

Question 14

therapuetic effect/mechanism Levosimendan

Answer 14

Troponin c to increase Ca sensitivity

Phosphodiesterase III inhibitor

Decreaseases LVEDP, afterload

increases stroke volume

Question 15

____ vein direct measure of right atrium

Answer 15

right internal jugular

Question 16

evidence of low perfusion

Answer 16

narrow pulse p

sleepy

low serum Na

Cool extremities

hypotension with ACE

renal dysfxn

Question 17

requirements for iontrope use

Answer 17

Advance systolic HF

Low output syndrome

hypotension

Vasodilators inffective/contraindicated

Fluid overload + unresponsive to diuretics (or renal failure)

Question 18

Cold and dry requires _____

Answer 18

cathetar placement to evaluate filling prossure

Question 19

goal of therapy > wet and warm

Answer 19

Decrease filling pressures (LVEDP, PCWP)

Question 20

diuretics with improved bioavailability and absorption

Answer 20

Butmetanide torsemide

Question 22

produced in atria and ventricles in response to stretch (more prognostic than diagnostic)

Answer 22

Brian natriuretic peptide Nt-pro-BNP

Question 23

balanced vasodilator

Answer 23

nitroprusside

Question 24

in DA, afterload increases due to impact on

Answer 24

a receptors

Question 25

WET PCWP RA Pressure

Answer 25

Wet PCWP \> 18 or RA Pressure \>8

Question 26

no congestion at rest =

Answer 26

dry

Question 28

ACE inhibitors target

Answer 28

afterload

Question 29

therapies besides placebo for wet and warm

Answer 29

none

Question 30

impact of alcohol

Answer 30

impaired contractility

Question 31

tachycardia decreases ____ time

Answer 31

diastolic filling time

Question 32

signs/symptoms of congestions

Answer 32

orthopnea/PND JVD Ascites edema Rales

Question 33

Dry PCWP RA pressure

Answer 33

Dry PCWP RA Pressure \>8

Question 34

wet and warm therapy

Answer 34

IV DIeuretics posible vasdoilators

Question 36

when to consider PA cath evalulation of PT for VAD or transplant Cardiogenic shock decompensation w/uncertain hemodynamic profile apparent inotrope dependence or refractory symptoms

Answer 36

uncertain hypotension or worsening renal fxn with empiric therapy

Question 37

P2 suggestss

Answer 37

RV volume or pressure overload

Question 38

at higher doses, DA...

Answer 38

tachycardia without increased ionotropy

Question 40

mechanism adn effect dobutamine

Answer 40

B1 agonist with weak B2 contractility and mild vasodilator

Question 41

measures left atrial pressure from venous side healthy 12-15

Answer 41

wedge pressure

Question 42

CBC testing of heart failure

Answer 42

anemia or hemoconcentration