Acute Heart Failure Flashcards Preview

Cardiovascular > Acute Heart Failure > Flashcards

Flashcards in Acute Heart Failure Deck (43):
1

Low perfusion at rest = 

cold

1

in Cold and Wet, diuresis will improve

cardiac output

1

ionotropic drugs if

cold and dry

cold and wet and normal SVR

1

most patients iwith acute decomp HF fall into this category

wet and warm

2

impact on cardiac oxygen consumption milrinone

not significant

4

risks of increased calcium with ionotropes

arrhythmias

5

limitations of nitroprusside

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

accumulation of thiocynate (esp if impaired renal fxn)

6

diuresis not possible if

renal perfusion impaired

7

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

milrinone

7

diuretic side effects

electrolyte abnml

hypotension

gout exacerbation

hearing loss

Digoxin toxicity

renal insuf

muscle cramps (if too rapid)

9

impact of hypervolemia on CVP

increases CVP

9

healthy perfusion at rest = 

warm

9

warm vs cold

cardiac index

cardiac index >2.2 = warm

9

side effects milrinone

hypotension

arrhythmia

tachycardia

10

congestion at rest =

wet

11

challenges of diuretics

braking - long term tolerance of natriretic response

rebound may lead to Na retention

long term tolerance due to tubular hypertrophy

12

Cl levels cold/wet/dry/warm

Warm/Dry - Cl normal

Warm/Wet - Cl normal

Cold Dry - Cl decreased

Cold/wet - Cl decreased

12

impact on mortality, diuretics

no improvement

14

therapuetic effect/mechanism Levosimendan

Troponin c to increase Ca sensitivity

Phosphodiesterase III inhibitor

Decreaseases LVEDP, afterload

increases stroke volume

15

____ vein direct measure of right atrium

right internal jugular

16

evidence of low perfusion

narrow pulse p

sleepy

low serum Na

Cool extremities

hypotension with ACE

renal dysfxn

17

requirements for iontrope use

Advance systolic HF

Low output syndrome

hypotension

Vasodilators inffective/contraindicated

Fluid overload + unresponsive to diuretics (or renal failure)

18

Cold and dry requires _____

cathetar placement to evaluate filling prossure

19

goal of therapy > wet and warm

Decrease filling pressures (LVEDP, PCWP)

20

diuretics with improved bioavailability and absorption

Butmetanide

torsemide

22

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

Brian natriuretic peptide Nt-pro-BNP

23

balanced vasodilator

nitroprusside

24

in DA, afterload increases due to impact on 

a receptors

25

WET

PCWP

RA Pressure

Wet

PCWP > 18

or

RA Pressure >8

26

no congestion at rest = 

dry

28

ACE inhibitors target

afterload

29

therapies besides placebo for wet and warm

none

30

impact of alcohol

impaired contractility

31

tachycardia decreases ____ time

diastolic filling time

32

signs/symptoms of congestions

orthopnea/PND

JVD

Ascites

edema

Rales

33

Dry
PCWP
RA pressure

Dry

PCWP

RA Pressure >8

34

wet and warm therapy

IV DIeuretics

posible vasdoilators

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

uncertain 

hypotension or worsening renal fxn with empiric therapy

37

P2 suggestss 

RV volume or pressure overload

38

at higher doses, DA...

tachycardia without increased ionotropy

40

mechanism adn effect dobutamine

B1 agonist with weak B2

contractility and mild vasodilator

41

measures left atrial pressure from venous side 

healthy 12-15

wedge pressure

42

CBC testing of heart failure

anemia  or hemoconcentration