Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
50 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
Name four major causes of diastolic heart failure.
|
Chronic hypertension with left ventricular failure
aortic stenosis with normal LV ejection fraction hypertrophic cardiomyopathy restricitive cardiomyopathy |
|
|
|
Define diastolic heart failure.
|
Preserved systolic function but heart cannot relax and fill.
|
|
|
|
What % of heart failure patients have diastolic heart failure?
|
30-50%
|
|
|
|
Name three possible causes of restrictive cardiomyopathy.
|
Hemochromatosis
Amyloidosis Sarcoidosis |
|
|
|
What are physical exam signs of decreased cardiac output?
|
tachycardia
cool extremities (periperal vasoconstriction) fatigue |
|
|
|
What are physical exam signs of fluid overload?
|
paroxysmal nocturnal diuresis
peripheral edema pulmonary congestion JVD exertional dyspnea orthopnea S3 gallop |
|
|
|
Name six systemic disease states that can cause heart failure.
|
Hypertension
Pulmonary hypertension Diabetes Viral myocarditis Hypo/hyperthyroid Infiltrative/inflammatory diseases sarcoidosis, amyloidosis |
|
|
|
Name four symptoms of pulmonary edema suggestive of heart failure.
|
dyspnea without exertion
orthopnea PND, paroxysmal nocturnal diuresis chronic nonproductive cough |
|
|
|
T/F: JVD can be a sign of heart failure.
|
true
|
|
|
|
What is the significance of finding hyponatremia with the discovery of heart failure?
|
It is a poor prognostic finding.
|
|
|
|
What are "fluffy" perihilar areas on Xray?
|
pulmonary edema
|
|
|
|
What is the main test you want to get after suspecting chf?
|
echo, to check wall motion and ejection fraction.
|
|
|
|
If you check heart with echo and find ??
then you proceed with assessment of volume status. |
ejection fraction is <40%
|
|
|
|
CHF dx: If volume assessment shows fluid retention, what is the next treatment step?
|
give diuretic, titrate to euvolemic state.
|
|
|
|
CHF: If volume assessment shows NO fluid retention, what is the next treatment step?
|
Give ACE inhibitor
|
|
|
|
Should ARBs be added to ACE inhibitors?
|
no
|
|
|
|
brand name of captopril ?
|
Capoten
|
|
|
|
brand name of enlapril?
|
Vasotec
|
|
|
|
brand name of Lisinopril?
|
Prinivil, Zestril
|
|
|
|
Where are beta blockers given in HEART FAILURE therapy?
|
after diuretice and ACE inhibitors in Class II or III heart failure.
|
|
|
|
What three beta-blockers are preferred for heart failure?
|
carvedilol 65% reduction in motr.
metropropolol 34% red. mort. bisoprolol 34% red. mort. |
In what conditions do you used spironolactone in treating HF?
|
|
|
What aldosterone antagonists are used in heart failure, and under what conditions?
|
Spironolacone, in class IV heart failure
(reduced mort by 36%) |
|
|
|
What must be checked if Spironolactone is used for heart failure?
|
serum potassium
|
|
|
|
A patient cannot take an ACE inhibitor. What is an alternative?
|
ARBs
isosorbide dinitrate + hydralazine |
|
|
|
What is the brand name for spironolactone?
|
aldactone
|
|
|
|
What is the brand name for hydralazine?
|
apros
|
|
|
|
What is the difference in efficacy between thiazide and loop diuretics over the long term?
|
thiazides have been shown to help symptoms and reduce mortality.
loop diuretics improve symptoms but do not help mortality. |
|
|
|
Digoxin reduces [mortality, rate of hospitalization, both].
|
hospitalization only
(does not reduce mortality) |
|
|
|
What is the brand name of Losartan?
|
Cozaar
|
|
|
|
Name heart medications which should NOT be used in (systolic) heart failure because they are actively harmful.
|
-some calcium channel blockers
--antiarrhytmic agents used for asymptomatic arrhythmias. -milrinone: increased mort 35%!!! |
|
|
|
What meds should be used for DIASTOLIC heart failure, and why?
|
The goal is to slow heart rate to allow ventricular filling. Consequently, the drugs of choice are beta blockers, with diltiazem and verapamil as second line.
|
|
|
|
What four beta blockers are best for diastolic heart failure?
|
propranolol
metoprolol timolol atentolol |
|
|
|
What is the brand name for propranolol?
|
Inderal
|
|
|
|
What is the brand name for metoprolol?
|
Lopressor
|
|
|
|
What is the brand name for atenolol?
|
tenormin
|
|
|
|
Generic name for Lopressor?
|
metoprolol
|
|
|
|
Generic name for Inderal?
|
propranolol
|
|
|
|
What medication can cause diuretic resistance?
|
NSAIDs
|
|
|
|
What heart murmur is often heard in patients with diastolic dysfunction?
|
s4
|
|
|
|
What is the most reliable clinical finding suggestive of heart failure?
|
orthopnea
|
|
|
|
What are "very helpful findings" when EF< 40 to dx HF?
|
LBBB
anterior Q waves abnormal apical wave |
|
|
|
What are (intermediate) helpful findings EF < 40 to dx HF?
|
pulse > 90
SBP <90 S3 crackles, dyspnea prior infarction |
|
|
|
BNP measures suggestive of HF?
|
> 76
or > 50 with dyspnea |
|
|
|
BNP is less accurate if pt is ?
|
fat
|
|
|
|
Other conditions besides HF in which BNP is elevated
|
Cor pulmonale, pulmonary HTN, acute pulmonary
embolus, aging, renal insufficiency |
|
|
|
Is there a benefit to adding ACEI to isosorbide + hydralzaine for African-AM pts?
|
yes
|
|
|
|
What are contraindications to using spironolactone for HF?
|
Cr > 2.5
K > 5 |
|
|
|
Give the order of therapies for HF.
|
1. Diuretic and salt restriction, if fluid retaining
2. ACEI 3. When stable, add b blocker 4. spironolactone |
|
|
|
t/T CRT can reverse cardiac remodeling.
|
true
|
|
|
|
VADs are used for pts in stage ?
|
IV
|
|
