• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/47

Click to flip

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;

47 Cards in this Set

  • Front
  • Back
Causes of high cardic output failure
1. Chronic anemia
2. Pregnancy
3. Hyperthyroidism
4. AV fistula
5.Wet beriberi
6. Pagets disease of bone
7. Mitral regurg*
8.Aortic insuff*
CHF systolic dysfunction
due to impaired contractiity as result of
1.recent MI or ischemic heart disease--> damged heart muscle decreases ejection fraction
2.hypertension-->cardiomyopathy
3.valvular heart dz
4.Post viral myocarditis
rarely--> alcohol abuse, radiation, hemachromatosis, thyroid dz
CHF diastolic dysfunction
impaired diastolic ventricular filling
-stiff muscles or impaired relaxation
Most common cause of Diastolic dysfn in CHF
myocardial hypertrophy
other causes of diastolic dysfn in CHF
valvular diseases- mitral stenosis, aortic stenosis, aortic regurg

or restrictive disorders i.e. sarcoidosis, hemachromatosis, amyloidosis
symptoms of Left side heart failure
1.dyspnea
2.orthopnea
3.PND
4.nocturnal cough
5. confusion and memory impairment
6.diaphoresis and cool extremities at rest
SIGNS of Left sided heart failure
1. displaced PMI- due to cardiomegaly
2. S3 gallop ( ventricular gallop)
3. S4 gallop
4. Crackles and rales at lung bases
5.Dullness to percussion
6.decreased tactile fremitus
7. Increased P2 intensity in S2 sound
S3 gallop
normal in children but PATHOLOGIC IN ADULTS
MOST SPECIFIC SIGN OF CHF
- follows s2 i.e. Ken-Tuck-Y
- heard with bell on apex
- due to rapid filling into non-compliant ventricle
s4 gallop
-hear at LSB with bell of stethoscope
- happens after atrial systole ejection into non complaint left ventricle
- preceded S1 sound i.e. TEN-ess-see
increased P2 sound in S2
Left sided heart failure sign
- indicative of pulmonary HTN
-heard on upper LSB
signs/symptoms of RHF
- pitting edema
right sided heave
-nocturia
- ascites
-JVD
hepatomegaly/hepatojugular reflex
TESTS to order for new CHF patient
- TTE( echo) - check for pericardial effusion, EF%
- ECG
-cardiac enzymes: rule out MI
- CBC- anemia
- CXR
CXR in CHF- what do u expect to see
-cardiomegaly
-kerley B lines ( pulmonary congestion sign)
-interstitial markings
-pleural effusion
Initial test of choice - CHF
TTE- TRANSTHORACIC ECHO*
-differentiates systolic vs diastolic dysFN
- differentiates cause i.e. valvular, pericardial or myocardial
most accurate test for CHF?
Nuclear ventriculography i.e TECH 99 scan
- not used often unless echo not useful and Pulm htn is severe
BNP in CHF
useful to differntiate COPD and CHF related dyspnea
-CHF indicated by BNP>150
NT-BNP
N-type pro BNP
more sensitive for CHF than BNP
age <75 --> >125 = CHF
age <75 --> >450 = CHF
bnp effect
-overall effect : natriuersis, decreases systemic resistance -->decreased blood volume, systemic blood pressure, increased cardiac output and ejection fraction
Treatment of CHF methods
1- lifestyle modifications
2.diuretics
3.spiranalactone
4.ace inhibitors
5. ARBS
6.B-Blockers
7.Digitalis
8.Hydralazine or Isosorbide dintrates
Lifestyle modifications of CHF
1.sodium restriction - under 4 mg/day
2.exercise
3.smoking cessation
4.daily weight monitoring
5.alcohol restriction
most effective symptomatic control of mild-moderate CHF
diuretics
- best in systolic heart failure, volume overload
True or false
Diuretics in CHF reduce mortality
false, they just relieve symptoms such as pulm edema and dyspnea
Most potent loop diuretic for CHF
Lasix/Furosemide
Best Thiazide diuretic for CHF?
HCT- hydrochlorothiazide
Spiranalactone in CHF
INCREASES SURVIVAL
-MUST monitor K+, renal FN
-effective for severe CHf i.e. stages 3-4
Alternative for spiranolactone in CHF
EPLERENONE
- no gynecomastia :)
CONTRAINDICATIONS FOR SPIRANOLACTONE
RENAL FAILURE
ace INHIBITORS- action in CHF
REDUCE MORTALITY AND PROLONG SURVIVAL IN **MILD, MODERATE OR SEVERE CHF!!
- Reduces preload and afterloadi.e venous + arterial dilation
Indications fo ACE inhibitors
left ventricular systolic dysFn i.e. EF <40%
-all patients with this even if asymptomatic
Initial treatment of CHF in symptomatic patients
ACE inhibitor + Diuretic!!!!!
std treatment of CHF
Ace inhibitor
loop diuretic
B-blocker
ACE inhibitor monitoring
BP( hypotension)
potassium, BUN,
Creatinine
s/e cough
B blockers advantages for CHF
decreases mortality esp in post -MI
- slows down tissue remodelling
- decreased heart rate -->decreased O2 demand
- anti-arrythmic effect
-anti-ischemic effect
Which B-blockers used for CHF
carvedilol(best)
metoprolol
bispropolol
digoxin use- chf
positive ionotrope
- monitor digoxin level regularly
- used for severe CHF, Afib, or EF<40%
- DOES not DECREASE mortality
digoxin toxicity s/e
Gi: nausea, vomitting, anorexia
cv: ectopic beats, AV block, aFIB
CNS: visual disturbances, disorientation
Medications reducing Mortality in CHF
B blockers
ace inhibitors /arbs
hydrazalazine /nitrates
spiranalactone
Calcium channel blockers used in CHF
Amlodipine, or Felodipine if indicated for Hypertension or angina
Most common cause of death in CHF
ventricular arrthymias
Mild CHF- class 1 to 2 TX
salt restriction- 4mg
ace inhibitors
loop diuretic - if volume overload
mild to moderate CHF- class 2 to 3 tx
salt restriction 4mg p/day
ace inhibitors
Loop diuretic
B-blocker
Moderate to severe CHF class 3-4 tx
Digoxin added with ACE inhibitor, diuretic
drugs contraindicated in CHF
Metformin- lactic acidosis
thiazidolidinediones - fluid retention
Nsaids- CHF exacerbation
diastolic dysfunction tx
B blockers
diuretics
DO NOT USE digoxin or spiranalactone
Acute decompensated HF
seen in left side- systolic dysFN or diastolic dysFN
-acute dyspnea with or without pulmonary edema, shows elevated filling pressures ( LV)
d/d pulmonary embolism, pneumonia, asthma
ACute decompensated HF tx
oxygen mask
diuretics- mos timportant- decreased preload
-dietary sodium restriction
-nitrates : if nitroglycerin if no hypotension
what to use in ACUTE DHF when drugs fail
try dobutamine
-digoxin takes time to work - chronic drug