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