Flashcards in CHF Deck (40)
What is the definition of Congestive Heart Failure?
Cardiac pumping capacity that is inadequate to meet the body metabolic needs.
What are some stats as to who gets Congestive Heart Failure?
It affects about 10% of men and 8% of women over 60y/o
The number of incidence is on the rise esp. over 65 y/o
5 year mortality after diagnosis is 50 percent
What are the 2 most common causes of Congestive Heart Failure?
CAD and HTN
Outside of the most common causes what are some other etiologies of Congestive Heart Failure?
Cardiomyopathies, valvular disease, cardiotoxins, arrhythmias and renal disease
Why may NSAIDS or thiazolidinedions cause Congestive Heart Failure?
They promote salt detention
Why may CCBs cause Congestive Heart Failure?
Due to their negative tropic effects on the heart. caused by the fact that they impede the transmembrane cellular calcium transport and activation of RAAS and Sympathetic NS
What happens to a person who has left sided Congestive Heart Failure?
It's systolic left sided heart failure (left ventricle remodeling secondary d/t MI, HTN or obstruction outflow process
What might you find in the physical exam of a patient with left sided Congestive Heart Failure?
2) Crackles and Rales
4) Orthopnea and Paroxysmal nocturnal dyspnea
5) Cheyne-stokes respirations
6) Diminished pulses, JVD, cyanosis, S3 gallop, murmurs and tachy
What happens to a person who has right sided Congestive Heart Failure?
There is a disruption in distal felling or contractility of RV secondary to MI.
What might you find in the physical exam of a patient with right sided Congestive Heart Failure?
1) Peripheral pitting edema
2) GI tract congestion (decreased appetite, ascites, hepatomegaly
3) JVD (more than left), RV hypertrophy
What kind of work up would you want to do for someone with Congestive Heart Failure?
Labs - CBC, CMP, Lipid panel, TSH, and B-natriuretic peptide (BNP) (BNP most specific d/t its response to strain
EKG - for hypertrophy/arrhythmia/tachy
ECHO - Essential for treatment diagnosis and management)
What are the BNP readings that would indicate if you may/may not have Acutely Decompensated Heart Failure (ADHF)
BNP less than 100 - ADHF unlikely
BNP btwn 100-500 - Baseline for LV dysfunction (ask if patient has cor pulmonale or acute pulmonary embolism( if yes, ADHF possible, if no ADHF likely
BNP more than 500 - ADHF likely
What would be some findings on a Chest X-ray for someone with Congestive Heart Failure?
1) Alveolar edema (bat's wing)
2) Kerley B lines (interstitial edema)
3) Darker ouside parts, whiter inside parts
4) Pleural effusion
6) Prominent upper lobe vessels
What are the 4 ACC/AHA stages of Congestive Heart Failure?
Stage 1 - High risk for CHF with no structural disorders of heart
Stage 2 - Structural disorders of heart, no CHF symptoms
Stage 3 - Past or current CHF symptoms that are associated with underlying heart disease
Stage 4 - End stage disease, requires special treatment strategies.
What are the NYHA stages of Congestive Heart Failure?
Stage 1 - No limitation on physical activity
Stage 2 - Minor limitations, comfortable at rest
Stage 3 - Marked limitations, comfortable at rest
Stage 3a - (no dyspnea at rest)
Stage 3b - (recent dyspnea at rest)
Stage 4 - Inability to carry on any physical activity w/o discomfort. Symptoms present even at rest
What would be the first thing you want to do to treat a patient with Congestive Heart Failure?
First treat the reversible causes (HTN, DM, CAD, arrhythmias and structural problems
What is the most effective agent for chronic symptom relief for a person with Congestive Heart Failure?
What are 3 diuretics that you may want to use for a patient with Congestive Heart Failure? What would you used them for?
Thiazide - for mild HF (HCTZ and chlorthiadole)
Loop - used for more moderate to severe HF (furosemide, bumetanide, torsemide_
Outside of diuretics what are other drugs that you may want to use to treat a patient with Congestive Heart Failure?
1) ACE -
2) ARB -
3) Beta Blocker
What are some side effects of ACEs.
cough, Hypotention (esp. after 1st dose), renal dysfunction, hyper-K+, dizziness
What are some side effects of ARBs
N/V/D and myalgias
When do you used Beta Blockers?
If the patient's symptoms are stable
What do Beta Blockers do?
Counteract elevations of catecholamines and symp NS
What are some side effects of Beta Blockers?
Hypotension, bradycardia, fluid retention
When would you use Digitalis
Recommended for patients with A-fib or failure to improve on other meds.
What are some warnings of Digitalis?
It produces HF exacerbations but also has increased mortality d/t arrhythmias and MI. Also can be toxic, especially for those with kidney problems.
When would you use vasodilators?
Generally reserved for those who have an inability to tolerate other meds or a failure to control systems. They improve SOB but have no improvement over limiting advanced HF
What are nitrates (NTG) used?
Most useful in acute exacerbations
What are side effects of Nitroglyerine
Hypotension H/A, long term tolerance, tachy