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14 Cards in this Set
- Front
- Back
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When should you admit someone with acute HF
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severely decompensated HF with: hypotension, worsening renal funciton, altered mentation
dyspnea at rest hemodynamically significant arrhythmia - including new onset of rapid Afib ACS |
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What are the common vasodilators used in HF?
and what are their MOAs, half life and what are the most useful in? |
IV Nitro - venodilator, arteriodilator at higher doses.. Half-life 3-5 min useful in patients with HF and MI
Nitroprusside - potent, balanced veno and arteriodilator. Half-life 2 min useful in severe HTN or severe valvular regurgitation. Need art-line nesiritide - greater decrease in PCWP than NTG but no impact on dyspnea |
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what are the 4 hemodynamic/clinical states of acute HF
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dry and warm
dry and col wet and warmwet and cold |
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What are the signs of low perfusion?
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cool extremities
low urine output altered mental status inadequate response to IV diuretics prerenal azotemia |
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What are the signs of congestion?
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high JVP
hepatojugular reflux peripheral edema S3 SOBOE rales recent weight gain |
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pathophys of ACHF
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low CO
elevated filling pressures - elevated PCWP, elevated RA pressure elevated SVR |
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What is the problem and soultion for dry and warm HF?
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De nada.
Stable HF |
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What is the problem and solution for wet and warm HF?
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volume overloaded, but preserved forward flow
diurese, diurese, diurese - often as easy as increasing vasodilators |
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what do you do if the patient with wet and warm HF fails to respond to diuretics?
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INCREASE DIURETICS
fluid restrict continuous diuretic infusion addition of second tpye of diuretic ultrafiltration IV vasodilators useful in pulmonary edema and severe hypertension (don't use if there is symptomatic hypotension) |
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What is the problem and solution for wet and cold HF?
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low CO and high filling pressures
treatment - diuresis and increase vasodilators IV inotropes are used when there is low EF and low output syndrome with: marginal BP <90 unresponsive to vasodilators poor response to diuretics worsening renal function |
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What is the problem and solution for dry and cold HF?
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usually don't get admitted unless end-stage
usually didn't start that way but were made that way by our interventions vasodilators if BP ok inotropes if low BP |
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heart transplant indications
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persistently severely symptomatic HF irrespective of LVEF once other causes of dyspnea are ruled out
-frequent hospitalizations -arrhythmic complications -cardiorenal absence of contraindications poor one-year survival failure to respond to maximal medical/device therapy |
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heart transplant contraindications
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primary systemic disease that may limit survival
- hepatic, pulmonary, or medical renal disease active infection documented noncompliance drug/EtOH abuse (3 months abstinence) active cancer DM with end organ damage significant cerebral vascular disease or PVD obesity/cachexia |
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Options for IV ionotropes
their MOA |
dobutamine - Beta1/2 agonist (3:1) causes mild arterial vasodilatation. Causes tachycardia
milrinone - causes vasodilatation, may cause severe and sustained hypotension dopamine - stimulates beta, alpha and dopaminergic receptors. Causes tachycardia. Good choice when inotropy and vasodilatation needed |
