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18 Cards in this Set
- Front
- Back
HFrEF is characterized by what?
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Dilated cardiomyopathy, the ventricles are dilated; dilatation causes thinner muscle and therefore reduced contractility.
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Causes
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CAD (80%)
HTN DM ETOH "alcoholic cardiomyopathy" VIRAL INFECTIONS CHEMOTHERAPY |
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Chemotherapy Agents causing HFrEF
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Doxirubacin, Trastuzamab
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Clinical findings of HFrEF
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s3 murmur, JVD ,dyspnea
peripheral edema parox nocturnal dyspnea orthopnea (?how many pillows used at night) fatigue |
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Diagnosis
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Chest Xray (cardiomegaly-- nonspecific but indicative.... pulmonary edema-- nonspecific but indicative)
BNP - can be falsely low in obese pts, secreted by myocardium, also, elevated in an exacerbation ECHOCARDIOGRAM - u/s of heart :: dilated chamber, EF percentage, |
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NYHA Heart failure classifications
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class 1 : asymptomatic
class 2: SOB c ADLS class 3: slightest activity will cause SOB class 4: SOB at rest |
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ACC/AHA stages of heart failures
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stage A: high risk, no structure or functional abnormalities
Stage B: structural abnormalities, asymptomatic Stage C: symptoms are now present Stage D: very severe symptoms even with medical optimization |
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HFrEF Med Mgmt DIURETICS
Monitor for WHAT when on diuretics |
Diuretics
symptom relief only. they do not relieve morbidity and mortality EXCEPT FOR SPIROLACTONE -loop diuretic (lasix) -thiazide diuretic (metolazone) -aldosterone blockers (aldactone) -sequential nephron blockade MONITOR WEIGHT & LYTES |
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HFrEF ACE INHIBITORS ('PRILS)
Monitor for WHAT when on ACE Inhibitors? |
1st line therapy for reduced EF: ACE inhibitors
decrease symptoms reduce ventricular size increase ejection fraction decrease risk for IM MONITOR FOR: Cough, angioedema, hypotension, crt, K+ |
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ARB's (angiotensin receptor blockers) ('sartans)
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similar benefits to ACE inhibitors
alt tx to ACE inhibitors controversy to ACE/ARB combo (inc risk of hyperK+) risky, no proven benefits to combo |
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Beta Blockers (olol's)
WARNINGS AND CONTRAINDICATIONS MONITOR FOR?? |
Improved systolic function
inc EF 5-10% reduced symptoms decreased risk of mortality NEVER START OR STOP DURING AN EXACERBATION!!! CONTRAINDICATED IN ASTHMA OR 2nd or 3rd AV BLOCK!!!! (bronchoconstriction, worsens av block) MONITOR FOR: bradycardia, hypotenion, bronchospasm |
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aldosterone blockers
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reduction in mortality, symptoms, hospitalization
def add to anyone stage 3 or 4 HF Monitor: K+, BP, Crt |
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For Afro Americans
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Hydralazine with Isosorbide Dinitrate
Reduces hospitalization but NOT mortality |
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MEDS TO AVOID IN PTs WITH HFrEF !!!
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AVOID Thiazolidinediones (DM MED) (ACTOS)
ANTI-ARYTHMICS NSAIDS |
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MAKE SURE FLU AND PNA ARE UP TO DATE!!
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MAKE SURE FLU AND PNA ARE UP TO DATE
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Consider ICD therapy
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decreased risk for sudden cardiac death
INDICATIONS: EF < 35 % , survival of > 1 yr |
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Consider Atrial Synchronized Biventricular Pacing
(different set of indications) |
very severe HF increased risk conduction delays
Indications: NYHA stage 3 or 4 despite max therapies EF < 35% Sinus Rhythm QRS must be wide, greater than 120msec |
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CARDIAC REHABILITATION
Cardiac rehabilitation (rehab) is a medically supervised program that helps improve the health and well-being of people who have heart problems. Rehab programs include exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life. |
improves symptoms and quality of life but does not improve mortality
Cardiac rehabilitation (rehab) is a medically supervised program that helps improve the health and well-being of people who have heart problems. Rehab programs include exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life. |