CHF

Question 1

What is CHF?

Answer 1

Heart’s inability to pump enough blood to the heart

Question 2

Who is most likely to have CHF?

Answer 2

> 75% population of 65 and older

Postpartum can cause risk of CHF - cardiomyopathy

Question 3

How does the body maintain homeostasis when cardiac output is low?

Answer 3

Kidneys will retain fluid, this will increase amount of blood returning to the heart to increase CO

Question 4

What is the Frank-starling principle?

Answer 4

Increased fluid retention in the kidneys leads to increased volume to the ventricles, which leads to increased stretching of the ventricles, which leads to increased contractability which leads to cardiac output

Question 5

What are the 4 types of causes of CHF?

Answer 5

Left sided (left ventricle)
Right sided (right ventricle)
Systolic
Diastolic

Question 6

What causes systolic CHF?

Answer 6

Ventricle is not contracting well = decreased CO

• Cardiac ischemia to ventricle
• Extremely high HTN (ventricles are using all their energy to overcome pressure in aorta)
• valvular heart diease

Question 7

What causes diastolic CHF?

Answer 7

Ventricle not able to distend well to receive adequate volume of blood

• Usually left ventricle due to HTN
• Hypertrophy

Question 8

CHF Signs/Symptoms Left Sided

Answer 8

Pressure backed up into lungs

• Dyspnea,
• orthopnea
• dyspnea on exertion
• pulmonary edema (crackles)
• non-productive cough
• exercise intolerance
• fatigue

Question 9

CHF Signs/Symtpoms for Right sided CHF

Answer 9

Pressure is backing up into venous system

• Fluid retention
• peripheral edema (pitting edema bilat)
• hepatic congestion
• JVD

Question 10

What is the most common type of CHF?

Answer 10

left ventricular systolic failure

Question 11

What is the most common cause of right sided heart failure?

Answer 11

Left sided

Question 12

Left sided physical findings?

Answer 12

• Crackles in base of lungs
• Pleural effusions (cavity)
• Expiratory wheezing/rhonchi
• enlarged LV impulse
• decreased S1
• murmurs
• S3
• Hypoxemia
• Displaced apical impulse

Question 13

Right sided findings?

Answer 13

• JVD
• elevated JVP
• Hepatomegaly
• peripheral pitting/edema

Question 14

Differentials:

Answer 14

AMI
PE
Pnuemothorax

Fluid Retention:
DVT
venous insufficiency
sodium retention

** Or HTN Emergency

**Drugs - CCBs can cause peripheral edema

Question 15

Labs for CHF?

Answer 15

BUN/Creatine (kidney function)
LFTs, Electrolytes (sodium and potassium)
CXR - look for cardimegaly, pleural effusion, pulmonary edema
EKG - arrhythmias, AMI
Electrocardiography - looking for valvular disease, poor LV/RV ejection, LVH

Question 16

Tx for acute exacerbation of CHF?

Answer 16

ABCs, IV, Monitor, O2

Treat reversible causes (AMI, HTN, arrythmia)

Monitor urine output

Question 17

Meds for treatment of acute CHF?

Answer 17

Diuretics:

• Furosemide 40mg IV, repeat if inadequate urine output after 30 min
• Bumetanide 1mg IV, repeat if inadequate urine output after 30 min

Question 18

Chronic treatment of CHF?

Answer 18

• lifestyle
• low sodium diet
• alcohol/smoking
• exercise
• MEDS
• ACEi
• Diuretics
• Nitro to reduce volume overload

Question 19

What kind of complications can CHF create?

Answer 19

Pulmonary Edema (treat with furosemide)
Cardiac Arrhythmias
Cardiac Rest

Question 20

MEDEVAC for CHF?

Answer 20

Yes

Question 21

How does the body maintain homeostasis when cardiac output is low?

Answer 21

Kidneys will retain fluid, this will increase amount of

Question 22

How does the body maintain homeostasis when cardiac output is low?

Answer 22

Kidneys will retain fluid, this will increase amount of