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Must Remember
Hemodynamics
| Question | Answer |
|---|---|
| Cardiac Output (CO) equals the volume of blood ejected in one minute from the left ventricle to the aorta and normally measures | 4-8 L/min |
| Cardiac Index (CI) indicates perfusion adequacy is normally measures | 2.5-4.0 L/min/m2 |
| CI <2.2 indicates | Hypoperfusion |
| Right Atrial Pressure (RAP/CVP) indicates right preload and normally measures | 2-6 mmHg |
| RAP>10 mmHg indicates | systemic venous congestion |
| Pulmonary Artery Wedge Pressure (PAWP) indicates Left Preload (LVEDp) and normally measures | 6-12 mmHg |
| PAWP >18 mmHg indicates | Pulmonary Congestion; fluid is backing up. |
| Cardiac Power Output (CPO) | >0.8 is normal |
| Systemic Vascular Resistance (SVR) | 800-1200 Dynes |
| CPO <0.6 indicates | severe cardiogenic shock |
| Pulmonary Artery Pulsatility Index (PAPi) | >1.5 is normal |
| PAPi <1.5 indicates | RV Failure |
| HR Goal in HFrEF is | 50-60 BMP because it reduces myocardial demand |
| ACEi (Lisinopril, Ramiprili, Enalapril) washout period before ARNI(Sacubitril-Valsartan) is added is | 36 hours |
| MRA (Spironolactone/Eplerenone) is contraindicated for | potassium > or equal to 5.5 mEq/L |
| Close creatinine monitoring for a value of | >2.5 mL/min |
| Cold & Wet : Low CI, high PAWP equals | hypoperfusion with congestion. Treat with inotrope +/- pressor |
| Warm & Wet: Normal CI, high PAWP | congested; treat with diuretics and vasodilators |
| Cold & Dry: Low CI, normal PAWP | consider cautious fluid challenge |
| Warm & Dry: Normal CI, Normal PAWP | patient is compensated. Optimize/maintain GDMT |
| HF patient who has persistent congestion; already on a loop diuretic. How do you treat? | Add a thiazide for sequential nephron blockade as this patient likely has diuretic resistance |
| Low CI, High PAWP, High SVR | Cardiogenic shock; treat with inotropes |
| High CI early, low SVR | Septic Shock; use norepinephrine |
| Low pre-load, low CI | Hypovolemic shock; Rapid Volume Resuscitation |
| Obstructive Shock presents as | RV pressure Overload ; represents a Pulmonary Embolism ; blood flow is blocked |
| Obstructive Shock: Cardiac tamponade. Treat with : | pericardiocentesis |
| 36 hour washout between ACEi and ARNI prevents | angioedema |
| HR remains high >70bmp on max betablocker, add | Corlanor (Ivabradine) |
| There is no mortality benefit using Corlanor (Ivabradine) | true |
| Add hydralazine + Isosorbide dinonitrate (Isordil) in which population of patients? | African Americans |
| K+ remains elevated on MRA | Reduce or hold due to risk of hyperkalemia |
| Normal BUN /Creatinine is | BUN 6-24 mg/dL, creatinine 0.5-1.2 mg/dL |
| Patient on GMDT with a mild rise in BUN/creatinine, you should | Continue GDMT. mild increase is permissible. |
| High RAP + High PAWP indicates | biventricular failure; both filling pressures elevated |
| High RAP + Normal PAWP indicates | Isolated RV Failure /pulmonary hypertension |
| PAWP >18- with dyspnea, treat with | diuretics/vasodilators |
| Cardiac Index (CI) improvement on dobutamine (inotrope therapy) indicates | improved/increased contractility |
| CPO (Cardiac Power Output) <0.6 indicates | severe cardiogenic shock |
| Cold + Wet+ hypotension, you should add | inotrope +/-pressor, ICU escalation |
| Warm + Wet + hypertension (indicating hypertensive flash pulmonary edema), should add | Vasodilators (like nitroglycerin) *Then diuretics, cpap/bi-pap |
| You have a patient with recurrent hospital admissions despite GDMT, you should consider | Advanced HF Therapy including LVAD and transplant evaluation |
| a rise in BNP or Brain Natriuretic Peptide reflects | stress in ventricle walls |
| Always treat this, not the numbers | the patient |
| Preload is defined as | the volume of blood in the ventricles at the end of diastole (loaded for the next squeeze; LVEDP Left Ventricular end diastolic pressure) |
| Afterload is defined as | the resistance the left ventricle must overcome to circulate blood (SVR Systemic Vascular Resistance) |
| Preload increases in | hypervolemia, heart failure, valve regurgitation |
| Afterload Increases in | hypertension and vasoconstriction |
| Preload equals | increased volume = increase stretch= increased force of contration |
| afterload equals | Increased resistance = increased force of contraction required to overcome resistance |
| stroke volume equals | the volume of blood ejected during systole. This is affected by preload, afterload and contractility |
| Cardiac Output (CO) is measured in this chamber of the heart? | Left Ventricle (to the aorta) |
| PA Pulmonary Artery Pressure is a measure of blood pressure in the | arteries that carries the blood from the heart to the lungs |
| normal PA is | 25/20 mmHg |
| ARNI | DECREASES MORTALITY, DECREASES REMODELING |
| Only Beta Blockers to DECREASE MORTALITY are | Metoprolol Succinate (Toprol XL), Carvedilol (Coreg), Bisoprolol (Zebeta) |
| what's the greater priority: symptom improvement or decreasing mortality? | decreasing mortality |
| Hyperkalemia >5.5, you should | adjust ARNI/MRA |
| what do you do first when facing hypotension: reduce GDMT or reduce diuretic? | Reduce diuretic |
| more than mild worsening of kidney function during diuresis you should | stop diuretic |
| you should only start a patient on a beta blocker when they are | euvolemic/stable |
| MRA's (Spironolactone /Eplerenone) aide in | blocking aldosterone, decreasing fibrosis |
| SGLT2i Jardiance and Farxiga decrease | HF hospitalizations and assist in osmotic diuresis |
| you have to be a diabetic to use an SGLT2i | false |
| Digoxin reduces | HF hospitalizations, NOT Mortality |
| true or false: loop diuretics decrease mortality | false; provide symptom relief only |
| over-diuresis equals | low preload |
| fluid bolus equals | preload restoration |
| Hallmark symptom of HF is | Paroxysmal Nocturnal Dyspnea; may be described as feeling suffocated or anxious |
| PND is caused by | the fluid in the lower extremities returning the central circulation while the patient is lying flat |
| The most common cause of HFpEF is | The stiffening of the left ventricle wall which can be caused by long standing hypertension, left ventricular hypertrophy, pericarditis |
| first sign of fluid retention | rapid weight gain, clothing feels tight around the waist, shoes feel tight |
| return of renal perfusion while a patient is laying in bed may cause | frequent nighttime urination |
| CHA2DS2-VASc is a 9 point | clinical tool used to assess the annual risk of stroke in patients with non-valvular atrial fibrillation (AFib) and to guide anticoagulation therapy. |
| CHA2DS2 score is important in assessing patient for risk of | stroke |
| A JVP or Jugular Venous Pressure of >3 cm above the sternal notch/Angle of Louis is | a positive finding caused by a fluid back up from THE RIGHT VENTRICLE |
| To assess the JVP for JVD the HOB should be | 45 degree angle; clothing, shoes and socks should be removed, examine from the right side |
| when listening for pulse, the Point of Maximum Impulse or PMI is normally found at | Mid clavicular, 5th intercostal space |
| Cardiomegaly may displace this sound. It may be found | down and laterally (may be difficult to find) |
| 3rd heart sound "Kentucky" | bell of stethoscope, created by inflowing blood against a dilated or non compliant ventricle , low frequency |
| 4th heart sound "Tennessee" | bell of stethoscope, created by stiff left ventricles (Ischemic cardiomyopathy, hypertension, aortic stenosis) low frequency |
| Systolic murmurs can be innocent but diastolic murmurs are always | pathologic |
| The only diastolic murmurs are | Mitral stenosis and Aortic regurgitation |
| 2 mm dent depth | +1 pitting edema ; disappears rapidly |
| 4 mm dent depth | +2 pitting edema; disappears in 10-15 seconds |
| 6 mm dent depth | +3 pitting edema; may last longer than a minute |
| 8 mm dent depth | +4 pitting edema ; may last 2-5 minutes |
| unintentional weight loss, early satiety, loss of appetite, general debility is usually seen in | end stage heart failure |
| narrowed pulse pressures less than 30 mmHg between systolic and diastolic pressures indicates | advanced heart failure; may be caused by tachycardia, severe aortic stenosis, pericardial effusion and/or ascites |
| orthostatic hypotension may be caused by | vasodilation, decreased cardiac output or decreased volume |
| a blood pressure drop of 20 mmHg systolic or a 10 mmHg diastolic drop with a HR drop of 20 BPM indicates | orthostatic hypotension |
| which medication can affect INR results? | amiodarone |
| a weight loss of 1 kg while diuresing your patient is equivalent to losing | 1 liter of fluid |
| an inch of increased abdominal girth is equal to retaining | 500 mL of fluid |
| Pulses alternans is defined as | alternating weak and strong peripheral pulses caused by SEVERE left ventricular dysfunction associated with a LOUD s3 gallop |
| A patient with Pulses alternans is associated with | a poor prognosis |
| Ventricular arrhythmias may be | life threatening and should be assessed and treated promptly |
| Depression in HF diagnosis may cause | decreased adherence to medication regimen and increased mortality |
| cognitive decline in patient may lead to | medication errors and ability to perform self care |
| A patient who walks less than 600 feet during a 6MWT predicts | increased mortality |
| A Cardiopulmonary Stress Exercise Test is the GOLD STANDARD for determining patients candidacy for | LVAD implant and Heart Transplant |
| a VO2 MAX < 14 mL/kg/min indicates a | poor prognosis |
| a V02 max is defines as | the maximum rate of oxygen your body can consume and utilize during intense, incremental exercise. it reflects how efficiently your heart, lungs, and muscles deliver and use oxygen |
| a change of 50 meters in distance in a 6MWT is considered | significant |
| Patient is on Entresto 24-26 mg BID. He complains of fatigue. BP 88/54. What should you do? | Down titrate to Losartan |
| A CRT can be placed for symptom control. Does it have to be placed with an ICD? | No it does not. It can just be placed for the resynchronization benefit. |
| Bisoprolol dosing is uptitrated starting at 2.5 mg daily and going to | 5 mg, 7.5 mg then 10 mg daily |
| there is a proven mortality benefit to adding Hydralazine and Isosorbide Mononitrate to the medication regimen. True or False | False. Isosorbide Mononitrate is Imdur. The correct combination is Hydralazine and Isosorbide Dinonitrate (Isordil) |
Created by:
DMolinary