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Nayla Foundations > CHF > Flashcards

CHF Flashcards

(55 cards)

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1
Q

What state does CHF result in

A

Hypervolemic state

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2
Q

What is CHF

A

inability of the heart to pump blood in proportion to metabolic demands
-A disease of aging

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3
Q

What is cardiac output of the heart governed by

A

Preload
After load
Contractile state of myocardium
Heart rate

CO=HRxSV

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4
Q

What happens in systolic HF

A

LV EF reduced

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5
Q

What happens in diastolic HF

A

altered ventricular compliance causes high filling pressures

EF not affected

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6
Q

What are the causes of Systolic HF

A 
#1: CAD with MI (ischemia in US)
#2: HTN
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7
Q

What are the causes of diastolic HF

A

Abnormal ventricular filling

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8
Q

What are causes of LV failure

A

arrhythmia
valve disease
cardiomyopathy

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9
Q

What are causes of RV failure

A

Left sided HF!

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10
Q

What is the ACC/AHA classification

A

Class A: high risk but no structural abnormality and no symptoms
Class B: Structural abnormality but asymptomatic
Class C: Structural abnormality with HF Symptoms
Claud D: Need intervention due to refractory HF

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11
Q

What is the NYHA classification

A

I: Asymptomatic
II: Symptomatic with moderate exercise
III: Symptomatic with minimal exercise
IIII: Symptomatic at rest

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12
Q

What are signs of LV HF

A 
Pulmonary HTN
Pulmonary edema
Crackles
Fatigue
Dyspnea
Elevated JVD
PND
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13
Q

What are signs of RV HF

A

Hepatomegaly
Peripheral edema
Anasarca
Ascites

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14
Q

What HF is hepatojugular reflux associated with

A

Both left and right

(looking for 4cm rise or fall

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15
Q

When is S3 seen

A

With CHF, indicative of fluid sloshing into the dilated ventricles

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16
Q

When is S4 seen

A

In diastolic failure, when the walls are too stiff to allow filling

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17
Q

What would you get a CBC to check

A

Anemia (low H&H), which causes a high output failure

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18
Q

What would a CMP reveal

A

hypo/hyperkalemia
hyponatremia
high BUN/Cr
hight LFT

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19
Q

What is BNP

A

enzyme released from heart in response to ventricular pressure overload

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20
Q

What are the important BNP levels

A

<100: NOT CHF

>400: consistent with CHF

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21
Q

What are optimal oxygen sat levels

A

> 92%

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22
Q

What ABG’s will you see with early CHF

A

Hypoxia
Hyperventilation
Respiratory ALKalosis

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23
Q

What ABG’s will you see with critical CHF

Study These Flashcards
A

Worsening CHF

Metabolic alkalosis

24
Q

What is cardiomegaly

Study These Flashcards
A

Cardiac silhouette is greater than 1/2 transthoracic diameter

25
What will you see on CXR in CHF
Cardiomegaly Kerley B Lines bilateral hilar infiltrates
26
What does a normal size heart with CHF indicate
Mitral stenosis Constrictive pericarditis AMI
27
What is the most useful non-invasive diagnostic tool for CHF
Echo | Evaluates Etiology and Extent of HF
28
What does a cardiac cath provide
Direct measurement of ventricular diastolic pressure | can show impaired relaxation and filling
29
What does "optimal therapy" require
Combo of: Multiple meds TLC Surgical therapies
30
What vaccines should HF patients receive
Flu | Pneumococcal
31
What is initial pharmacologic therapy in HF
combination of diuretic and ACE-I
32
What drug should be AVOIDED in HF
CCB- can worsen HF
33
What do diuretics do
Decrease preload in fluid overload patients (make you pee out so you have less fluid that fills the ventricles)
34
What diuretics are good for outpatient management, though they are not as good as loops
Thiazides
35
What diuretics are most useful in CHF patients
Loop diuretics
36
Why is Spironolactone good to add to loop and thiazide
It is an aldosterone antagonist, and aldosterone is usually high in CHF
37
What must you monitor when taking Spironalactone
Hyperkalemia
38
What do ACE-I do
reduce both preload and after load
39
When are ARB's useful
When patients are unable to take ACE due to angioedema or cough
40
Who are BB especially useful in
all stable patients with HF! | Hx MI, EF <40% and asymptomatic, stable HF
41
What are BB known to do
reduce hospitalizations, sudden death, overall mortality in CHF
42
What drug relieves symptoms but does NOT improve survival
Digoxin (increases CO)
43
What med should be considered for Af.Am. patients and those who remain symptomatic despite optimal therapy
Direct vasodilators (Hydralazine, Isosorbide)
44
What is optimal therapy for Af. Am. HF patients
Beta blockers and ACE inhibitors
45
What does Nitroglycerine do
Venous dilation to decrease preload
46
What drug dilates both arteries and veins
Sodium Nitroprusside
47
Who should receive an ICD
Patients with life expectancy longer than 1 year, previous MI and LVEF <30%
48
Who should receive a Biventricular pacemaker
NYHA class III or IV with EF <35%
49
What is treatment for CHF stage A patients (ACC/AHA)
TLC | ACE-I
50
What is treatment for CHF Stage B patients (ACC/AHA)
Every TLC for stage A ACE/ARB and BB ICD if EF <30%
51
What is treatment for CHF Stage C (ACC/AHA)
Everything TLC for A&B, salt restriction Diuretics, ACE, and BB ICD or Biventricular pacemaker
52
What is treatment for CHF Stage D (ACC/AHA)
``` Everything for A, B, and C Compassionate end of life care Chronic inotropes LVAD Heart transplant ```
53
When would a patient need to be URGENTLY hospitalized
``` New signs of congestion Increased dyspnea Anasarca/ascites Severe decompensating HF New A-Fib ```
54
When would you need to IMMEDIATELY hospitalize a patient
with pulmonary edema/ respiratory distress Desat <90% SBP <75 Confusion d/t hypoperfusion
55
What are important markers of poor prognosis
``` Need for hospitalization Poor compliance Age gender cause race ```

Nayla Foundations (18 decks)

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