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Flashcards in congestive heart failure Deck (13):
1

SOB (↑ sympathetic system/anxiety: tachycardia, ↑ PVR → worsen heart failure)
-dyspnea on exertion (most sensitive sx)
dull bilaterally, ↓ BS, pleural effusions
cough: pink, frothy
bilateral leg pitting edema
orthopnea
paroxysmal nocturnal dyspnea
cardiomegaly, pansystolic murmur, JVD
low SpO2, HTN
nonspecific: weakness, lightheadedness, ab pain, malaise, wheezing, nausea
+/- hx of HTN, CAD, CM, valve disease

congestive heart failure

2

work-up for congestive heart failure

CXR
serial cardiac enzymes (acute MI could be trigger)
BNP
serial EKG
CBC (infection or anemia (↑ CO) can trigger CHF), electrolytes (response to heart failure: H20 + Na retention, K excretion; ACEi + diuretics can cause abnormalities), BUN, Cr, LFT (↑ venous congestion →↑LFTs)
echocardiogram

3

initial treatment of congestive heart failure

IV furosemide: diuretic + immediate bronchial vasodilation
optimize O2 exchange: O2 by NC, dilate pulm vasculature, ↓ cardiac preload and afterload
morphine sulfate: ↓ anxiety assoc with SOB + venodilator mostly (↓ preload → ↑ CO)
IV nitroglycerin: ↓ myocardial O2 demand by ↓ preload and afterload, ↓ bp
↓ preload + afterload, ↓ cardiac remodeling:
ACEi + B blocker

4

cause of congestive heart failure

most common: CAD, HTN

5

dilated LV → impaired contractility

systolic dysfunction CHF

6

LV can't relax, fill → can't eject blood

diastolic dysfunction CHF

7

venous congestion
N/V, distension/bloating, constipation, ab pain, ↓ appetite
pitting edema, weight gain, JVD, hepatojugular reflex, hepatic ascites, slenomegaly

right-sided heart failure

8

pulmonary congestion
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, wheezing, tachypnea, cough
bilateral pulmonary rales, pleural effusion, pulmonary edema (first manifestation of CHF)
S3 gallop rhythm
Cheyne stokes respiration

left-sided heart failure

9

common symptoms of left and right sided heart failure

tachycardia
CM
cyanosis
oliguria
nocturia
peripheral edema
weakness, fatigue, delirium, insomnia, HA, stupor, coma, paroxysmal nocturnal dyspnea

10

gold standard modality in presence of CHF

echocardiogram

11

outpatient management of CHF

↓ Na (2-4 g/day) + fluids
caloric restrictions, exercise
antihypertensive
ACEi (if CHF + ↑ LV function): ↓ preload + afterload, ↑ CO, inhibit RAAS, ↓ mortality, delay symptomatic CHF if asymptomatic with reduced EF
B blocker (systolic or diastolic CHF, if class II or III CHF or if CAD): initial low-dose, titrate up over several weeks, ↓ sympathetic tone, ↓ cardiac remodeling, ↓ mortality if EF

12

ACEi contraindications

pregnant
hypotension
↑ K
bilateral renal artery stenosis
caution if renal insufficiency

13

CCB used with caution in CHF

peripheral vasodilation
↓HR
↓ contractility
↓ cardiac conduction