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36 Cards in this Set
- Front
- Back
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When should you treat CHF with Oxygen?
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moderate to severe cases
whenever hypoxia is present clinical detection of syanosis |
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How would one dose oxygen for CHF?
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nasal cannula 2-6 L/min unless they have COPD, then 1-2 L/min
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What considerations should be made for a patient's comfort during oxygen therapy?
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use a humidifier to counteract the dryness, add essential oils to the humidifier, do not allow oxygen to escape into the eye
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What Physical Therapy modalities can be useful in CHF?
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Spondylotherapy, Diathermy, Colonics - not to the point of debility/watch for increase in fluid volume load
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What ACE inhibitors are approved by the FDA for CHF?
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Captoril 20-150 mg/day
Enalapril 5-20mg/day Lisinopril 5-40 mg/day Quinalapril 10-40 mg/day Trandolapril 1-4 mg/day Fosinopril 5-40 mg/day Ramipril - for CHFp MI |
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Considerations when prescribing an ACE inhibitor for CHF
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They are often under prescribed and dosed
Closely monitor BP/K/renal status NCQA required all CHF pts to be on ACE inhibitors |
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Diuretics used in CHF
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Loop: Furosemide & Toremide oral or parenteral
Metolazone Combination: Furosemide + |
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Beta Blockers in CHF
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all pts
Metaprolol succinate or Carvedilol Underprescribed and underdosed |
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BNP
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Brain Naturetic Peptides normally <100
cause vasodilation |
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Systolic heart failure treatment
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suspect with history of MI, Diuretics, Beta-blocker, ACEI, Spiranolactone, Digoxin
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As or Systolic LV Failure
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ACEi
ARBs - if intolerant to ACEi Aldosterone Antagonist (spiranolactone) Abstain from Alcohol |
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Bs of Systolic LV failure Meds
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Beta Blocker
BNP |
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C's of Systolic LV failure Meds
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Combo - nitrates + hydralazine
Coumadin Cardiac ionotropes - dopamine/dobutamine |
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D's of Systolic LV failure Meds
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Diuretics
Digoxin Diet (restricted sodium, limit water) |
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A's of Diastolic Failure
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Avoid Digoxin
ACE Inhibitor |
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B's of Diastolic Failure
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Beta Blockers
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C's of Diastolic Failure
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Calcium Channel Blockers Amlodipine -- avoid Verapamil and Diltiazem
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D's of Diastolic Failure
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Diuretics
Diet |
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Heart Failure and Diabetes
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ACEi
Beta Blockers with caution -- Carvediol Diuretics --loop Vasodilators |
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Exercise in Heart Failure
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CI in unstable, but then useful lower HR if dyspnea on exertion, 30-40 min 3x weekly monitor
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Reasons for readmission in HF pts
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Failure to seek medical attention
Inadequate follow up Failed social support system Non compliance with diet or drug Inadequate discharge planning |
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When to hospitalize a CHF patient
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Respiratory distress, tachypne>40/min, pulmonary edema
hypoxia O2 sat<90% Anasarca recent CHF onset Ischemia (chest pain) Inadequate social support Failure of outpatient management Significant concomitant acute medical condition |
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Basic Treatment Guidelines for CHF
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Oxygen
Water Calories Protein-carb-fat ratio Amino acids-sugars-fatty acids Vitamins and minerals Optimal absorption into cells |
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Three C's of botanical medicine for valve disease
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Cactus
Crataegus Convallaria |
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Botanicals for BP
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Rauwolfia
Veratrum Crataegus Celery seed Magnesium SAMe Spironolactone Triamterene ACEi |
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Botanicals for Chronic coagulation disorder with COPD
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Nattokinase
ASA Bromelain, panaz, ginkgo Proteolytic enzymes |
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Name preload and afterload reduction interventions
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ACEi
Bed rest Constitutional Hydrotherapy Coleus Diuretics (watermelon seed tea) diuretics and ACEi best |
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Treatments to help with expectotic dreaniration
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NAC, mucolytic drainage, SSKI 3-10 drops, marrbium, Grindelia, Xanthoxyllu, Zingiber, Glycirrhiza, Lobelia, Sanguinaria, hydro after breathing and clapping
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Homeopathy for edema
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Apis, anasarca, apocynum
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Homeopathy for valvuar disease
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Lact. Mac. Constitutional or Acute
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Homeopathy for COPD, bronchitis
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Ant-tart
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Homeopathy for MI
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Lact. Mactans, Naja, Lauroc, Oxalic acid
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Homeopathy for SOB
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Carbo veg, Veratrum alb, Ant t, Lauro (Cheyne Stokes Respiration)
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Homeopathy for Atrial Fibrilation
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Digitalis, Lycopus
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Homeopathy for Myocardial Degeneration
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Crataegus
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Homeopathy for Cyanosis
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Lauro (red), Ant. t (white), Carbo v (blue), Oxalic acid (wiped)
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