Heart Failure HF

wasabi's version from 2015-10-14 18:56

Section 1

Question Answer
drugs that adversely affect HF:NSAIDS, corticosteroids, anything with sodium and water retention
failure to pumpsystolic heart failure
fail to fill because of stiffness (hypertrophy)diastolic heart failure
what is the key to tell between diastolic and systolic hf?ejection fraction. must do an echocardiogram
what are some signs of low perfusion?decreased urine output, skin cold/clammy, brain...fatigue....confusion
heart prob but no symptoms class?one
symptoms with sig exertion class?two
symptoms with mild exertion class?three
symptoms at rest class?four
signs means?things can observe.....labs and phys findings
symptoms means?what patient is experiencing
non dihydropyridine calcium blockers?bad for heart failure in systolic. not prob diastolic really.
is diastolic or systolic hf right or left?both!
BNP =stretch from heart failure BNP secreted. opp of aldosterone.
BNP of what = HFover 400
BNP of what most likely not HF?less than 100
poor perfusion will causevasoconstriction. alpha one
with poor perfusion what happens to BUN and sc?increased BUN:Cr ratio
pulse pressure means?diff between systolic and diastolic
bad cardiac output expect BP to be?low blood pressure because cardiac output not good
compensation do what with BP?will bring back up but not to the 120/80
cardiomyopathyweakening of heart muscle. ischemic from CAD or MI, alcoholic, viral
hypertrophyincrease in thickness of muscle mass. not necc size. usually from chronic HTN
dilated cardiac myopathy=systolic heart failure
vasoconstriction of arteries flow?decrease. decreased cardiac output. volume is needed to supply organs.
vasoconstriction is BAD for cardiac output
renin, angiotensin, aldosterone!
angiotensin 2 does what?vasoconstriction and stimulate aldosterone (sodium and water reabsoprtion)
cough potentially ACE ask?productive? is coughing stuff up pry not ACE associated
ACE and ARB teratogenic
do not add an ARB to ACE and beta blocker comboincreased mortality
do not add ARB to aCE
normal ejection fraction60%
diastolic dys ejection fractionover 50%
systolic dys ejection fractionbelow 40%

Section 2

Question Answer
diuretics will do what to preload?will cause it to go down but cause cardiac out put to decrease
diuretics must do what?balance! monitor fluid balance so keep in middle where functioning
short term on diuretic want them to los ehow much a day?1 kg. 1 liter of fluid. 1000 ml of water
insensible loss700 mls a day of sweating, breathing, etc so must add to the fluid loss
ideal dose of chronic diuretic in hf is?zero. able to do that often? no cuz will get edema and SOB. want to give as little as possible
side effect of diuretics?BUN/cr ratio up, potassium down,
do orthostatic bp for hydration status diureticsbp when stand up and down
thiazides side effects hyper....glucose, lipids, uric acid, urea, calcium
only one really diff between loops and thiazides side effects?loops down lower calcium
diuretics help mortality?no but help symptoms
torsemide dose what compared to lasix?half
ace inhibitors do whatdilate veins and arteries. preload better and afterload better. arterial side dilate flow up and heart workload down. venous side more more space so less pressure and fluid down and diuretic like effect cuz block aldosterone
ACE inhibs do what to potassium?goes up.
ACE inhibs get what with kinins?increase. good cuz vasodilation so afterload reduction but side effects
ACE inhibs flow arterial and venous?arterial flow up and cardiac output increase. and venous flow down
ACE inhibs incredibly beneficial!!!!
dose of ACE?lick it dose. their BP is going to drop
caution of giving ACE?have hyponatremia
adverse of ACE?BUN/cr up, potassium up, hypotension, cough, angioedema
ACE inhibs and mortalitysave lives. do help mortality
ARBs do what?look like ACE but do not affect kinins
ARB dosinglick it dose
beta blockers and mortality?decreases.
beta blockers do what?negative inotropic effect. decrease HR and cardiac output.
beta blockers doseuse lick it dose. start low and go slow. use toprol not tartrate!
beta blockers never use when?if heart failure not stable!
beta blockers used in hf?toprol, carbetalol, bisoprolol
on beta blocker better knowheart rate
beta blockers side effectsvivid dreams (more nightmares lipophilic), depression, bronchospasm,
someone come in bad heart failure stop beta blocker?no. keep same and diurese or drop one dose at very most
aldosterone antags do what?
alodsterone potassium sparing?yes because block aldosterone, can cause hyponatremia
aldosterone and mortality?enourmous decrease in mortality!
digoxin does whatincrease contraction
digoxin no use for?diastolic dysfunction
on digoxin checkheart rate cuz slows
digoxin and mortality?no increase. last line
adverse effects of digoxintoxicity, blurred vision, bradycardia, dwindles, pee more, nausea, any arrythmia
more likely to be dig toxic if low potassium
digoxin rolesymptom control and rate control in AF and HF. last choice