Orthopnea( worse when lying flat, relieved when sitting up or standing) peripheral edema rales on lung exam

paroxysmal nocturnal dyspnea( sudden worsening at night, during sleep) S3 gallop

CHF Flashcards by Zoya Kosmodemyanskaya

SOB( dyspnea) - essential feature of

CHF

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Low ejection fraction and dilation of heart(CHF)

Systolic dysfunction

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EF is preserved ( CHF)

* heart can’t relax and pump blood

Diastolic dysfunction

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Causes of systolic dysfunction

HTN=> cardiomyopathy, preservation of EF=> over time heart dilates=> syst dysf and low EF

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Valvular heart disease if all types results in

CHF

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MI is a very common cause of

Dilated cardiomyopathy and decreased EF

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Most common cause of hospital admission in USA

CHF

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MI death rate down from

thrombolitics
BB
angioplasty
aspirin, clopidogrel

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Causes of systolic dysfunction CHF

Infarction => dilation => regurgitation=> CHF

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Less common causes of systolic dysfunction CHF

Alcohol,postviral( idiopathic) myocarditis,radiation,
adriamycin( doxorubicin) use, Chagas ds, hemochromatosis, thyroid disease
, peripartum cardiomyopathy, thiamine deficiency

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Hemochromatosis causes …. cardiomyopathy

Restrictive

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CHF presentation

Orthopnea( worse when lying flat, relieved when sitting up or standing)
peripheral edema
rales on lung exam

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CHF presentation

paroxysmal nocturnal dyspnea( sudden worsening at night, during sleep)
S3 gallop

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Sudden onset dyspnea, clear lungs

Pulmonary embolus

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Sudden onset dyspnea,wheezing, increased expiratory phase

Asthma

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Dyspnea slower, fever, sputum, unilateral rales/rhonchi

Pneumonia

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Decreased breath sounds unilaterally, tracheal deviation

Pneumothorax

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Circumoral numbness, caffeine use, history of anxiety, dyspnea

Panic attack

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Dyspnea, pallor, gradual over days to weeks

Anemia

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Pulsus paradoxus, decreased heart sounds, JVD, dyspnea

Tamponade

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Palpitations, syncope, dyspnea

Arrhythmia

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Dyspnea, dullness to percussion at base

Pleural effusion

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Long smoking history, barrel chest, dyspnea

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COPD

Recent anesthetic use, brown blood not improved with 02, clear lungs on auscultation, cyanosis

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Methemoglobinemia

Burning building ir car, woodburnung stove in winter, suicide attempt

Carbon monoxide poisoning

Orthopnea/PVD, S3, diagnostic test

CHF=> echocardiography( distinguish systolic vs diastolic)

CHF. What is the best initial test?

Transthoracic echo

CHF.What's the most accurate test?

Multiple-gated acquisition scan( MUGA) or nuclear ventriculography

More accurate for valves

Transesophageal echocardiography

When should you answer" nuclear ventriculography"?

* rarely needed * person receiving chemotx with doxorubicin * trying to give max dose to cure lymphoma, but not to cause cardiomyopathy

Atrial natriuretic peptid( BNP)

Acute SOB, etiology unclear, you can't wait for echo

Normal BNP excludes

CHF

Distinguishes CHF from ARDS; not routine

Swans-Ganz right heart catheterization

Systolic dysfunction (low EF) tx

* ACE inh or ARBs * BB ( carvedilol, bisoprolol, metoprolol) * aldosterone antagonists( spironolactone, eplerenone) * diuretics * digoxin

CHF tx: antiischemic, decrease heart rate, decrease O2 consumption, antiarrhythmic

What is the MCC of death from CHF?

Arrhythmia/sudden death

Only proven for more advanced CHF( class III and IV) with dyspnea on minimal exertion or at rest

Spironolactone

MC adverse effect of spironolactone

Hyperkalemia, gynecomastia

Antiandrogenic effect

Spironolactone

CHF tx . Diuretics( furosemide, torsemide, bumetanide) . ED/office

ED: acute pulmonary edema Office: combination with ACEi or ARB

Control symptoms of CHF. Do not lower mortality

Diuretic, digoxin

Is not used at doses where it has a diuretic effect. CHF

Spironolactone

Decrease frequency if hospitalizations, control symptoms

Digoxin

No positive inotropic agent has been proven to lower mortality

Digoxin, milrinone, amrinone, dobutamine

Devices with mortality benefit. CHF

Implantable defibrillator: ischemic CM & EF < 35%

EF < 35%& wide QRS > 120ms with persistent symptoms

Biventricular pacemaker

Has wire in R atrium and R ventricle

Dual-chamber pacer

Not a dual-chamber pacemaker

Biventricular pacemaker

Resynchronizes the heart when there's a conduction defect

Biventricular pacemaker

Defers/delays need for cardiac transplantation

Defers/ delays need for cardiac transplantation

Symptoms despite maximal medical therapy( ACE, BB, spironolactone, diuretics, digoxin) and possibly biventricular pacemaker

Transplantation

CHF. Always wrong in absence of clot in heart

Warfarin

Mortality benefit in systolic dysfunction

* ACEi/ARBs * BB. • Spironolactone. * Hydralazine/ nitrates * implantable defibrillator

Can raise mortality

Calcium-channel blockers

Diastolic dysfunction( CHF with preserved EF) tx

* BB * no mortality benefit in diastolic dysfunction * digoxin has NO benefit * diuretics( if fluid overload)

Do not confuse diastolic dysfunction from hypertrophic CM with hypertrophic obstructive cardiomyopathy.Tx

Diuretics are contraindicated in HOCM because they increase obstruction

CHF Flashcards

(56 cards)