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ADHF
Acute decompensated heart failure
| Question | Answer |
|---|---|
| What stage are patients with persistent/refractory symptoms despite oral therapy based on ACC/AHA staging system? | Stage D |
| What class are patients that experience symptoms with mild or moderate exercise based on NYHA functional class? | III(mild)-IV(moderate) |
| What are possible causes for ADHF? | -Lifestyle/Medication non-adherence -Acute insult(AFib, acute coronary syndrome) -Disease progression |
| What is the body response to ADHF? | Activation of RASS(increase in sodium & water retention -> preload) and SNS(incrase in SVR->afterload); arginine vasopressin secretion -> free water retention -> hyponatremia |
| How is ADHF diagnosed? | -Dyspnea -BNP > 100 pg/mL |
| Reasons for false BNP elevation(2) | -Pneumonia -Pulmonary embolism |
| Use of pulmonary artery catheter/swan ganz catheter help improveoutcomes) T/F) | False |
| What are indications for PAC(3)? | -Patients not responding to initial therapy -Pts whose volume status cannot be determine by hx of physical examination -Pts experiencing hemodynamical instability during tx |
| How are pts with CI < 2.2 L/min/m2 classified? | Cold |
| How are pts with CI> 2.2 L/min/m2 classified? | Warm |
| How are pts with PCWP of > 18 mmHg classified? | Wet |
| How are pts with PCWP of 15 - 18 mmHg classified? | Dry/Euvolimic |
| What is a normal PCWP? | 6-12 |
| What is a normal value for SVR measured using PAC? | 800-1200 dyne*sec*cm5 |
| What values of SVR are considered a vasoconstricted state? | >1200 dyne*sec*cm5 |
| What values of SVR are considered a vasodylated state? | <800 dyne*sec*cm5 |
| Clinical presentation of pulmonary edema? | Crackles, hypoxemia, dyspnea, orthopnea, elevated PCWP |
| Clinical presentation of peripheral edema? | Ascites, hepatomegaly/hepatojugular reflux |
| Goal of treatmet of ADHF? | Restoration of hemodynamical stability and correction of fluid overload |
| When should beta blockers be d/c in the setting of ADHF? | Cardiogenic shock or clinically significant hypotension |
| If a pt presents with ADHF and acute kideny injury which medications should be discontinued? | RAAS, digoxin(renally excreted --> acumulation) |
| Why might ACE/ARBs and MRA be stopped? | Decreased urine output might mean higher risk for hyperkalemia if already hyperkalemic upon admission. |
| What are three common vasodilators? | Nitroglycerin, nitroprusside, nesiritide |
| What is the place in therapy of IV vasodilators? | Persistent ADHF despite aggressive treatment with diuretics in the absence of hypotension(SBP < 90 mmHg) |
| Nitroglyerin effect at high vs low dose? | Low dose: Venous dilation --> decreased preload High dose: Arterial dilation --> decreased SVR --> increased CI MOA: Nitric oxide donor |
| When should we expect tolerance development from Nitroglycerin? | After 12 hours(might need to increase dose) |
| What is Nesiritide MOA? | Recombinant BNP which promotes natriuresis, venous and arterial vasodilation. |
| What is Nitroglycerin MOA? | Nitric oxide donor |
| Place in therapy of IV ionotropes | Diuretic refractory patients with low CO or symptoms of hypo perfusion. |
| Mechanism of action of Dobutamine? | Non-selective beta agonist with alpha 1 adrenergic agonist effects. |
| Mechanism of action of Milrinone? | PDE3 inhibitor |
| What are major cardiovascular concerns with ionotropes? | Arrhythmias: Sinus tachycardia, ventricular tachycardia, Afib |
Created by:
olimac
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